CAT-SCRATCH DISEASE IN 2 CHILDREN PRESENTING WITH FEVER OF UNKNOWN ORIGIN - IMAGING FEATURES AND ASSOCIATION WITH A NEW CAUSATIVE AGENT, ROCHALIMAEA-HENSELAE

Objective. To report the clinical course, imaging findings, and method of diagnosis of two patients with systemic manifestations of cat scra tch disease, presenting with fever of unknown origin. Design. Case stu dy. Patients, Two children with fever of unknown origin who had multip le lesions in the liver and spleen, shown an ultrasound, computed tomo graphy, and magnetic resonance imaging. Initial diagnoses were Kawasak i disease (case 1) and metastatic neuroblastoma (case 2). Results. Bio psy material showed granulomatous hepatitis in both patients. The diag noses were confirmed by positive assays for Rochalimaea henselae, curr ently thought to be the causative agent of cat scratch disease. Conclu sion. Cat scratch disease presenting as fever of unknown origin is now well described and can be more readily diagnosed because of the avail ability of new serologic assays, as well as polymerase chain reaction assays for R henselae DNA in tissue specimens.