A 14-YEAR-OLD African American boy presented with right-sided facial swelling, mild trismus, and a low-grade fever of 6 days' duration. He had a pet kitten, although he did not recall having been scratched. His medical history was unremarkable. On examination, there was a firm, 3-cm, tender mass with indistinct margins overlying the angle of the mandible on the right side. The findings of the rest of the head and neck and systemic examinations were unremarkable. A computed tomographic scan with contrast (Figure 1) showed posterior cervical adenopathy and a hypodense mass involving the masseter muscle. A magnetic resonance imaging scan was also obtained (Figure 2). A complete blood cell count and a biochemical profile were normal, and the results of a purified protein derivative skin test were negative. A fine-needle aspirate of the mass showed granulomas with peripheral palisading of epithelioid histiocytes and central microabscesses (Figure 3). Extracellular argyrophilic pleomorphic bacilli were seen after the cytologic material from the aspirate was processed with the Warthin-Starry silver stain (Figure 4).
Kacker A, Kuhel WI, Hoda RS. Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2000;126(5):676-680. doi: