Cat scratch disease as a cause of immune purple thrombocytopenic

Abstract

Objective: Describe the case of a school boy with cat scratch disease associated with thrombocytopenic purpura, as an atypical manifestation of Bartonella henselae infection. Material and methods: Review of medical history, with clinical suggestive picture, epidemiological antecedent and confirmed by serological test.

Results: Male patient of 8 years, goes to emergency with 10 days of illness characterized by fever of 38.5 - 39.5 °C, increase in volume in right forearm for 7 days, 3 days petechiae in chest, abdomen and palate, plays with his cat of 3 months and does not have antecedent is pathological contributory. On examination increase in right arm volume, epitrochlele adenopathy 4 cm in diameter, restraint, delimited, little painful, with surrounding erythema, ancient slags in both arms and petechial lesions; unaltered examination. Hgr: 17,800/mm3, Hb, 12.3 g/dl, platelets 3,000/ mm3. PCR: 5 mg/dl, TORCH serology, EBV, Viral hepatitis and brucella (-), IgM > 1:180 for Bartonella henselae, coagulation profile, Rx chest and normal abdominal ultrasound. PPD: 2 mm. Ultrasound of soft parts right arm confirms adenopathies. Receive Gammaimmunoglobulin IV 1gr/Kg/day one dose, Azithromycin for 10 days. Favorable clinical and laboratorial evolution in approximately 13 days. At high prednisone month, with complete remission.

Conclusions: Thrombocytopenic purpura is a rare complication of EAG, treatment should include antibiotic administration and intravenous human immunoglobulin such as immunomodulator and corticotherapy to maintain remission of associated complication.