Unsuspected extra lymphocutaneous dissemination in febrile cat scratch disease

Cat scratch disease (CSD) commonly manifests as regional self-limited lymph adenitis. However, dissemination of the infection to distant multiple sites may occur even in immunocompetent patients. We report a series of 11 child ren with fever and extralymphocutaneous manifestations of CSD, in order to highlight potential multiorgan involvement in patients with febrile CSD. To be eligible for enrolment, patients had to present with involvement of sit es other than regional lymph nodes. The diagnosis was based on suggestive c linical criteria, histological findings and positive serology. The utilizat ion of ultrasound imaging revealed hepatic lesions in 3 children and spleni c lesions in 8 children, whereas osteolytic lesions were observed in 4 chil dren by bone scan. Hepatic or splenic involvement was not suggested by clin ical signs or biochemical investigation in 2/3 and 6/8 children, respective ly. Bone involvement was supported either by relative symptoms or signs. Ou r findings indicate that, in the presence of fever, extralymphocutaneous ma nifestations have to be anticipated in patients with clinically suspected C SD. The systematic use of imaging modalities in patients with serologically documented Bartonella henselae infection could contribute to a better unde rstanding of the clinical spectrum of CSD.