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Special Feature
January 5, 2009

Picture of the Month—Diagnosis

Arch Pediatr Adolesc Med. 2009;163(1):86. doi:10.1001/archpediatrics.2008.514-b

Shortly after the biopsies were performed, the child's father was available to provide additional history. The father was scratched by the family's kitten shortly after its acquisition 1 month before. He was given penicillin prophylaxis. He developed a fever and axillary lymphadenopathy 1 week later, a course of illness that suggested cat-scratch disease.

Pathologic specimens demonstrated small, rodlike organisms on Warthin-Starry staining of the lymph node (Figure 3B, inset). The B henselaegenome was detected by polymerase chain reaction testing of the muscle tissue. Convalescent B henselaeserology remained at the same titers (IgM < 1:16; IgG, 1:128) as during the acute phase of the illness. Cat-scratch disease is a well-known cause of fever and lymphadenopathy in children. The causative agent, B henselae, is a pleomorphic, aerobic, gram-negative bacterium commonly found in the oral flora of cats and kittens as well as other animals.1

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