Disseminated cat-scratch disease presenting as nausea, diarrhea, and weight loss without fever in a heart transplant recipient

Annukka A R Antar; Amit Goyal; Karly Murphy; Matthew Schimmel; Nisha A Gilotra; Isabella Martin; Genevieve Marie Crane; Christopher Sciortino; Robin K Avery; Brian A Houston

doi:10.1111/tid.12678

Disseminated cat-scratch disease presenting as nausea, diarrhea, and weight loss without fever in a heart transplant recipient

Transpl Infect Dis. 2017 Jun;19(3). doi: 10.1111/tid.12678. Epub 2017 May 26.

Affiliations

¹ Division of Infectious Diseases, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
² Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
³ Division of Cardiology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁴ Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, USA.
⁵ Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
⁶ Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.

PMID: 28199763
DOI: 10.1111/tid.12678

Abstract

We report the case of an afebrile 59-year-old heart transplant recipient presenting with nausea, vomiting, diarrhea, weight loss, and diffuse lymphadenopathy. Lymph node biopsies revealed non-caseating granulomatous inflammation. Cat-scratch disease was confirmed by serologic studies, Warthin-Starry staining, and polymerase chain reaction testing of lymph node tissue. The patient's symptoms resolved with 3 months of doxycycline. We review clinical presentations of Bartonella henselae infection and review diagnostic approaches for B. henselae in this patient population.

Keywords: Bartonella henselae; gastrointestinal illness; granulomatous inflammation; solid organ transplant.

Publication types

Case Reports

MeSH terms

Anti-Bacterial Agents / therapeutic use*
Bartonella henselae / isolation & purification*
Biopsy
Body Temperature
Cardiomyopathies / surgery*
Cat-Scratch Disease / complications
Cat-Scratch Disease / drug therapy
Cat-Scratch Disease / microbiology*
Cat-Scratch Disease / pathology
Diarrhea / drug therapy
Diarrhea / etiology
Diarrhea / microbiology
Doxycycline / therapeutic use
Heart Transplantation / adverse effects*
Humans
Immunosuppressive Agents / adverse effects*
Lymph Nodes / diagnostic imaging
Lymph Nodes / pathology
Male
Middle Aged
Nausea / drug therapy
Nausea / etiology
Nausea / microbiology
Polymerase Chain Reaction
Serologic Tests
Tomography, X-Ray Computed
Weight Loss

Substances

Anti-Bacterial Agents
Immunosuppressive Agents
Doxycycline