Cat-scratch disease in the parotid gland: A challenge in differential diagnosis

Background: Bartonella henselae is the causative agent of cat-scratch disea se (CSD), an inflammatory infection of the lymph nodes. So far, only few ca ses of atypical manifestations in the head and neck, especially manifestati ons in the parotid gland have been reported. Patients and Methods: Between January 1997 and June 1999 seven patients with manifestations of CSD in the parotid gland were observed at the ENT-department Freiburg. The positive d iagnosis was confirmed serologically by an indirect immunofluorescence assa y and by detection of Bartonella henseloe-DNA with PCR-amplification and su bsequent hybridization or sequencing. Results: An intraglandular abscessed lymphadenitis was found in five patients, two of these cases were based on a Parinaud's oculoglandular syndrome. A diffuse affection of the parotid gl and, initially misinterpreted as a parotid tumor, was seen in two patients. Conclusions: Antibiotic treatment is recommended in order to reduce the du ration of the disease, in cases of pain and lymph node abscesses. In uncomm on manifestations of CSD, the nosological assignment can be difficult on th e basis of the heterogeneous symptomatic in the individual patient and the CSD diagnosis can only be confirmed by serology or PCR-based techniques. CS D should be considered in the differential diagnosis of all equivocal masse s in the head and neck, even in unusual localisations like the parotid glan d.