Cutaneous vasculitis revealing a cat-scratch disease

Background. We describe a case of cat-scratch disease ingnaugurated by vasc ular purpura and discuss the role of the causal agent, Bartonella henselae. Case report. A 49-year-old woman presented vascular purpura without fever. Skin biopsy demonstrated leukocytoclasic vasculitis. She owned a cat and a had a scratch scar on the back of her left hand. A few days later, two infl ammatory epitrochlear lymph nodes suppurated. Cat-scratch disease was confi rmed by serology and PRC analysis of pus aspirated from the nodes. The purp ura resolved spontaneously in three weeks. Left axillary adenopathy develop ed and suppurated. In spite of four antibiotics, the nodes subsided only te n months later, leaving scars. Discussion. Two arguments favor Bartonella henselae as the causal agent in this cutaneous vasculitis. The simultaneous onset of the two diseases and t he absence of another cause of vasculitis, This patient did not have Barton ella henselae endocarditis which could have explained this vasculitis. Only one case of hypersensitivity vasculitis ha been described during cat-scrat ch disease. The exceptional feature of this association is perhaps the resu lt of the unawareness of moderate or asymptomatic cat-scratch disease. Bart onella henselae was possibility caused hypersensitivity vasculitis.