Assistant Professor in Pediatric Critical Care Medicine Baylor College of Medicine, United States
Introduction: Fever, lymphadenopathy, and generalized malaise are pathognomonic of typically self-limiting Bartonella henselae infections. Less common manifestations include endocarditis, osteomyelitis, ophthalmologic disorders, hepatosplenic lesions, and encephalitis. In this report, we describe an atypical case of pediatric Bartonella henselae presenting solely with lymphadenopathy and seizures.
Description: A 5-year-old previously healthy female with one month of unilateral cervical lymphadenopathy presented with sudden onset of altered mental status and seizures. No other associated symptoms or fever. In the EC, she was intubated and required Ativan and Keppra for treatment of status epilepticus. She was started on vancomycin, ceftriaxone, and acyclovir which were eventually discontinued given negative blood cultures, lumbar puncture, and HSV and enterovirus CSF PCR. Autoimmune CSF markers were negative. Stroke protocol MRI, spot EEG, and ophthalmologic exam were within normal limits. She was rhinovirus positive which is likely an incidental finding given the lack of infectious and respiratory symptoms. Due to her stable clinical exam and negative workup, she was extubated and subsequently returned to her baseline neurologic status. Upon further interview, it was revealed there was a new kitten in the home. She was started on a 10-day course of azithromycin for presumed Bartonella henselae infection which was later confirmed with positive Bartonella IgG titers.
Discussion: This case was unique as the patient had isolated lymphadenopathy and seizures secondary to Bartonella henslae without fevers or other typically presenting symptoms. This case underscores the gravity of comprehensive interviewing, particularly in cases with abnormal constellations of symptoms. Examination of all possibly involved systems can avoid delayed diagnosis and treatment. Though this patient only had neurologic involvement, examination of all potentially related systems was essential as this could have led to an earlier diagnosis. When presenting symptoms do not suggest a clear etiology, assessing environmental or social circumstances can lead to diagnosis and expeditious treatment.
