Abstract:
Issue: Bartonella henselae is associated with benign cat-scratch disease in healthy children, or bacillary angiomatosis, retinitis, prolonged and severe malaise, disseminated infections in HIV-infected immunodeficient adults. We here describe the diagnostic and therapeutic challenges of a severe B. henselae submandibular lymphadenitis in an HIV-infected child with partial immunodeficiency. Case report: A 3 year-old male caucasian born to an asymptomatic HIV-positive mother was doing well on IVIG and Zidovudine since the age of 6 months. His HIV infection was classified as stage B2 (CD4+ count above 800/mm3) at time of admission for a febrile left submandibular lymphadenitis. US examination revealed abscess formation, which led to surgical incision and drainage. Culture of pus was positive for a group A streptococcus. A first histological examination of an adjacent lymph node indicated features of follicular hyperplasia. In spite of intravenous antibiotic treatment, recurrent abscess formation occured in adjacent nodes of the left submandibular area and required additional surgical procedures. The child eventually improved slowly when administered imipenem, which had to be maintained for 5 weeks. A repeat biopsy obtained 3 weeks after admission revealed histological features suggestive of cat-scratch disease - although less prominent than in immunocompetent individuals - confirmed by positive specific coloration for B. henselae. Serology was non contributive. Discussion: Partial immunodeficiency did not allow this 3 year-old HIV-infected boy to build the strong immune responses usually induced by cat-scratch disease and resulting in positive serology and typical histopathological findings. Thus, B. henselae infection should be considered in the differential diagnosis of localized lymphadenitis in HIV-infected children even in the absence of classical diagnostic criteria. It requires prolonged administration of antibiotics active against B. henselae, but does not necessarily lead to disseminated infection as observed in adults with more advanced immunodeficiency.
Keywords: *Cat-Scratch Disease/COMPLICATIONS *HIV Infections/COMPLICATIONS 970130
M9715892
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