Yin Qi-Ling, Liu You-Qiong, Zhang Hui-Min, Zhang Ya-Le, Qi Shu-Min, Wen Jin-Quan, Zhang Wei-Hua
Department of Pediatric, Shaanxi University of Chinese Medicine, Xianyang 721000, Shaanxi Province, China.
Department of Pediatric Respiratory, Rainbow Hospital of Xianyang (Children's Hospital of Xianyang), Xianyang 721000, Shaanxi Province, China.
World J Clin Cases. 2024 Dec 16;12(35):6840-6847. doi: 10.12998/wjcc.v12.i35.6840.
Cat scratch disease (CSD) is the most common human infection caused by (). The main manifestation is self-limited lymphadenopathy that primarily affects adolescents, and typically resolves without treatment within 2-4 months. However, individuals with compromised immune systems or immunodeficiency require specific antibacterial therapy following diagnosis. Due to its low incidence, nonspecific clinical manifestations, and diagnostic limitations, this condition often poses challenges for clinicians in terms of missed diagnoses and misdiagnoses.
The child was ultimately diagnosed with CSD. The primary manifestations included nocturnal fever, enlargement of lymph nodes in the neck, axilla and groin, and suspected brucellosis; however, both brucellosis tests conducted during the course of the illness yielded negative results. Bone marrow cytology indicated stimulated proliferation. Lymph node biopsy indicated hyperplasia of lymphoid tissue in the cervical lymph nodes (right), with combined immunohistochemical findings indicating reactive hyperplasia. Immunohistochemical analysis revealed CD20 B (+), CD3 T (+), BCL-6 (+), and BCL-2 (-). CD21 FDC networks were present and Ki67 expression in the germinal center was ~80%. Blood next-generation sequencing indicated sequence number was 3. Serological test results demonstrated positive antibody response to IgG (+), IgM (+), () IgG (-) and IgM (-), and the final diagnosis was CSD.
In patients presenting with fever at night and swollen lymph nodes of unknown origin, CSD should be considered.
猫抓病（CSD）是由（）引起的最常见的人类感染。主要表现为自限性淋巴结病，主要影响青少年，通常未经治疗在2 - 4个月内自行缓解。然而，免疫系统受损或免疫缺陷的个体在诊断后需要特定的抗菌治疗。由于其发病率低、临床表现不特异以及诊断局限性，这种疾病在漏诊和误诊方面常常给临床医生带来挑战。
该患儿最终被诊断为猫抓病。主要表现包括夜间发热、颈部、腋窝和腹股沟淋巴结肿大，疑似布鲁氏菌病；然而，病程中进行的两次布鲁氏菌病检测结果均为阴性。骨髓细胞学显示有增殖活跃。淋巴结活检显示颈部淋巴结（右侧）淋巴组织增生，免疫组化结果综合显示为反应性增生。免疫组化分析显示CD20 B（+）、CD3 T（+）、BCL - 6（+）和BCL - 2（-）。存在CD21滤泡树突状细胞网络，生发中心Ki67表达约为80%。血液二代测序显示序列数为3。血清学检测结果显示对（）IgG（+）、IgM（+）、（）IgG（-）和IgM（-）抗体反应呈阳性，最终诊断为猫抓病。
对于出现不明原因夜间发热和淋巴结肿大的患者，应考虑猫抓病。
