Denouement and Discussion
A skin pustule or papule resembling an insect bite may be present up to 30 days after the patient is scratched by a cat. Rarely, it develops after a dog or monkey bite or a scratch from a thorn or splinter. With careful scrutiny, the inoculation site can be detected in the majority of patients.Approximately two weeks (range, three to 50 days) after the scratch, regional lymphadenopathy develops in the epitrochlear, axillary, cervical, supraclavicular, submandibular, periauricular, or inguinal areas. The enlarged lymph nodes are painful and tender for one to three months. Most enlarged nodes subside spontaneously, but some suppurate, soften, and drain.Fever, malaise, headache, rash, and flulike symptoms are present in about one third of affected patients. Other clinical manifestations include Parinaud's oculoglandular syndrome, neurologic symptoms, osteomyelitis, thrombocytopenia purpura, a specific type of pneumonia, and erythema nodosum. Laboratory tests are not
Willems PJ, Gerritsen J, Mulder HJ, van Loon JM, Feingold M. Picture of the Month. Am J Dis Child. 1986;140(1):57–58. doi:10.1001/archpedi.1986.02140150059035
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