Systemic Bartonella henselae infection with hepatosplenic involvement

Background: Systemic manifestations of Bartonella henselae infection are ra re in the immunocompetent host. The infection generally has initial symptom s of prolonged fever and multiple granulomatous lesions in liver and spleen . Methods: Retrospective analysis of the records of all patients with hypoech ogenic lesions in the liver and/or spleen diagnosed from 1990 through 1996 in three pediatric clinics in northern Italy, Results: Among the 13 patients reviewed, 9 had evidence of B. henselae infe ction and hepatosplenic involvement: five had prolonged and unexplained fev er lasting from 3 to 16 weeks, and four had typical cat-scratch disease and peripheral lymphadenitis. All patients had increased sedimentation rate an d normal aminotransferase serum activity. Five children had a liver biopsy, by laparotomy in three and by needle in two, In all, the predominant liver lesion was a necrotizing granuloma. All patients were treated with broad-s pectrum antibiotics. Fever lasted from 3 to 16 weeks, and hepatic and splen ic lesions resolved in all with residual splenic calcification in one. Conclusions: Systemic B, henselae infection represents an important cause o f inflammatory hypoechogenic hepatosplenic lesions in children. Serology pr ovides rapid diagnosis, avoiding multiple and invasive investigations, Hepa tosplenic involvement can be found even in children with typical cat-scratc h disease without apparent systemic manifestations. The frequency of liver and/or splenic involvement in cat-scratch disease is probably underestimate d.