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Syndrome of Rochalimaea henselae Adenitis Suggesting Cat Scratch Disease

Matthew J. Dolan, MD; Michael T. Wong, MD; Russell L. Regnery, PhD; James H. Jorgensen, PhD; Maria Garcia, MA; John Peters, PhD; and Dennis Drehner, DO
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From Wilford Hall USAF Medical Center, Lackland AFB, Texas; the Centers for Disease Control, Atlanta, Georgia; the University of Texas Health Science Center, San Antonio, Texas. Requests for Reprints: Matthew J. Dolan, MD, Department of Infectious Diseases, Wilford Hall USAF Medical Center, Lackland AFB, TX 78236. Acknowledgments: The authors thank Dr. Theodore E. Woodward and Dr. Gregory P. Melcher for review of the manuscript.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1993;118(5):331-336. doi:10.7326/0003-4819-118-5-199303010-00002
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Objective: To describe a clinical syndrome of cat scratch disease caused by Rochalimaea henselae, including methods for isolation of the organism from tissue and for identification.

Design: Case series.

Setting: U.S. Air Force referral hospital infectious diseases clinic.

Patients: Two previously healthy patients.

Main Measurements and Results: Two immunocompetent patients who had handled cats developed unilateral upper-extremity adenitis associated with a distal papular lesion and fever. The adenitis and distal lesions persisted and progressively worsened. Cultures of the involved lymph nodes from both patients grew R. henselae, a recently described organism associated with bacillary angiomatosis and peliosis hepatis in human immunodeficiency virus-infected patients and with bacteremia in immunocompromised and immunocompetent hosts. The organism was characterized as oxidase negative and X-factor dependent and had a characteristic pattern in analysis of whole-cell fatty acids differing from Afipia felis, a bacterium that has been associated with cat scratch disease. The identity of the isolate was confirmed by analysis of whole-cell fatty acids using gas chromatography and by amplification of the citrate synthetase gene sequence and analysis of the polymerase chain reaction-amplified product. The organisms were broadly susceptible to a variety of antimicrobials by broth microdilution; however in vitro resistance to first-generation cephalosporins correlated with clinical failure of therapy.

Conclusion: Rochalimaea henselae can be a cause of cat scratch disease in immunocompetent patients.


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Figure 1.
Photomicrographs of the papular hand lesion and lymph node of Patient 1.Top left.Top right.Bottom.

Granulomatous inflammation in the skin lesion. (Original magnification, × 50.) Rare multinucleated giant cells in the skin lesion. (Original magnification, × 470.) Perivascular inflammation in the involved lymph node. (Original magnification, × 230.) All samples were stained with hematoxylin and eosin.

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