SHM Converge Scientific Abstract ePoster Gallery-Disseminated Infection With Bartonella Henselae in a Drug-Induced Immunosuppressed Adult

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This case report describes a 62-year-old malnourished man with rheumatoid arthritis on prolonged prednisone who presented with one week of fever, malaise, and headache. He had significant cat exposure at home (18 cats), raising suspicion for Bartonella henselae infection. Although he initially had no lymphadenopathy, he developed septic shock, thrombocytopenia, worsening agitation, and encephalopathy requiring intubation.  <br /><br />Workup showed negative bacterial and fungal cultures from cerebrospinal fluid, but CSF analysis revealed pleocytosis and elevated protein. Bartonella serology was notable for a negative IgM with very high IgG titer (1:1280), supporting prior or ongoing infection. Brain CT was unremarkable. The patient was treated with doxycycline for cat scratch disease and voriconazole after scant Aspergillus flavus was found in sputum culture. He improved clinically and had no residual neurologic deficits.  <br /><br />The report emphasizes that cat scratch disease, usually a self-limited cause of regional lymphadenopathy, can rarely disseminate in immunocompromised patients and cause serious complications such as encephalopathy, thrombocytopenia, and septic shock. Neurologic involvement is uncommon, occurring in a small minority of cases, and may present with headache followed by altered mental status. The authors recommend considering Bartonella henselae in immunosuppressed patients with cat exposure even when lymphadenopathy is absent, and highlight the importance of obtaining an animal exposure history before starting immunosuppressive therapy.

Asset Subtitle

Celin Rajan

Meta Tag

Author List Celin Rajan, Ileana Elita Mendez, Jacinto-Omar Kadour-Rodriguez, Muhammad Jamal, Sreejith JagadeesanPillai

Category Clinical Vignettes

Concept Bartonella henselae

Concept Cat exposure

Concept Immunosuppression

Concept Lymphadenopathy

Concept Encephalitis

Distinguished Non-Finalist

Presenter Organization University of Texas Rio Grande Valley Knapp Medical Center

Presenting Author Celin Rajan

Track Adult

Keywords

Bartonella henselae

cat scratch disease

immunocompromised

encephalopathy

septic shock

thrombocytopenia

prednisone

cat exposure

cerebrospinal fluid

doxycycline

Bartonella henselae

Cat exposure

Immunosuppression

Lymphadenopathy

Encephalitis