Clinical Manifestations

In the head and neck, atypical manifestations of CSD appear in up to 14% of patients, specifically Parinaud's oculoglandular syndrome (6%), encephalopathy (2%), and osteomyelitis (0.3%); other atypical manifestations are hepatic granulomas (0.3%) and pulmonary disease (0.2%) (7). In general, these complications resolve without sequelae. Parinaud's oculoglandular syndrome is manifested by conjunctival granuloma, periauricular lymphadenopathy, and nonsuppurative conjunctivitis. Encephalopathy, manifested as fever and coma that progress to convulsions, may last for days to weeks; cerebrospinal fluid is unremarkable. Other atypical presentations may commence with arthritis, synovitis, thrombocytopenic purpura, or erythema nodosum. Optic neuritis with transient blindness may also occur. Specifically, neuroretinitis manifests as fairly sudden loss of visual acuity, usually unilaterally, sometimes preceded by an influenza-like syndrome or development of unilateral lymphadenopathy. The most striking, if not most common, retinal manifestation is papilledema associated with macular exudates in a star formation, although this is not pathognomonic and usually follows a favorable spontaneous course.

Among patients with this disease, 50% have involvement of a single node, 20% have involvement of several nodes in the same region, and 30% have involvement of nodes in

TABLE 3 Typical and Atypical Features of Cat-Scratch Disease

Typical features of CSD

Chronic tender lymphadenopathy (49%)

Fever (38-41°C) lasting 1-7 days (32%)

Malaise or fatigue (30%)

Anorexia, emesis, weight loss (15%)

Headache (14%)

Splenomegaly (11%)

Pharyngitis (8%)

Transient truncal maculopapular rash (5%)

Atypical features

Conjunctival granuloma with conjunctivitis and

(16%) of CSD

preauricular adenopathy (6%)

CNS, including encephalopathy/encephalitis with seizures,

combative behavior, extreme lethargy, or coma (2%)

Cranial/peripheral nerve involvement, including facial nerve paresis,

myelitis, neuroretinitis, polyneuritis, radiculitis, optic neuritis with

transient blindness

Thrombocytopenic purpura

Osteitis/osteomyelitis (0.3%)

Hepatomegaly/hepatosplenomegaly with hepatic granulomata (0.3%)

Skin symptoms, including erythema nodosum, erythema marginatum,

erythema multiforme

Pulmonary disease (0.2%)

Abbreviations: CSD, cat-scratch disease; CNS, central nervous system.

Abbreviations: CSD, cat-scratch disease; CNS, central nervous system.

multiple sites (7). In 80% of cases, the lymphadenopathy ranges from 1 to 5 cm. While the majority of lesions regress over two to six months, they may last for as long as two years. Suppuration is seen in about 10% of cases. Cellulitis is rare (Table 3).

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