Acute generalized cat scratch disease in myelodysplastic syndrome

In patients with normal immunity, cat scratch disease typically develop a p apule at the portal of entry and no other cutaneous features. A 73 year old male patient with a myelodysplastic syndrome developed generalized petechi al, papular and, vasculitic skin lesions in association with cat scratch di sease. After the diagnosis was established by identifying the causative org anism in a lymph node biopsy, the patient was treated with erythromycin for three weeks resulting in progressive clearance of the skin lesions. Apart from the soluble IL-2 receptor, no other serologic inflammatory parameters were elevated. IgG antibodies against Bartonella henselae and Bartonella qu intana increased only slightly during acute exacerbation of the disease, bu t significantly increased some months later. The diagnosis was established by the positive staining of the lymph node biopsy using the Warthin-Starry stain.