BOF: 2.39
A 16-year-old male presents with fever and a lump in the
neck. The patient was well till a week prior to presentation when he developed
fever and a tender lump in his neck was felt.
No past history of significance, no recent sore throat.
He has not been on any medications. No history of foreign travel. No ingestion
of undercooked meat. He gave a history of being scratched when playing with
the family pet (a cat).
On examination he was febrile temperature 39°
C. there was a single palpable lymph node in the left posterior triangle
6 cms in diameter. It was tender but no overlying erythema no fluctuation.
No skin lesions. No hepatosplenomegaly.
Other systems were normal on
examination.
Investigations revealed:
Normal FBC and biochemistry.
ESR 91 mm/h
Serology positive for Toxoplasma,
CMV EBV
In this patient the likely
causative organism is likely to be:
a)
Brucella melitensis
b)
Ricketsia prowazeki
c) Mycobacterium marinum
d)
Streptococcus pyogenes
e)
Bartonella henselae
Answer:
e)
The history of fever and lymphadenopathy following a cat
scratch would suggest cat-scratch disease, which is caused by Bartonella
henselae.
