Expressive aphasia as a presentation of encephalitis with Bartonella henselae infection in an immunocompetent adult

To show the first clinically reported case of Cat Scratch Disease (CSD) presenting as a focal neurologic deficit in an immunocompetent adult. 59-year-old male with a history of a previous stroke. Examination showed an expressive aphasia, word substitution errors, and impaired repetition. A head CT a...

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Bibliographic Details
Published in:The Yale journal of biology & medicine 2010-06, Vol.83 (2), p.67-71
Main Authors: Marienfeld, Carla B, Dicapua, Daniel B, Sze, Gordon K, Goldstein, Jonathan M
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - administration & dosage
Antibiotics
Aphasia
Aphasia, Broca - diagnostic imaging
Aphasia, Broca - etiology
Aphasia, Broca - physiopathology
Bartonella henselae
Bartonella henselae - isolation & purification
Bartonella Infections - complications
Bartonella Infections - diagnostic imaging
Bartonella Infections - microbiology
Bartonella Infections - physiopathology
Case Report
Cat scratch disease
Differential diagnosis
EEG
Electroencephalography
Encephalitis
Encephalitis - complications
Encephalitis - diagnostic imaging
Encephalitis - microbiology
Encephalitis - physiopathology
Epilepsy
Etiology
Fever
Humans
Immunocompetence
Immunoglobulin G
Immunoglobulin M
Infections
Lymphadenopathy
Male
Meningitis
Middle Aged
Neurological complications
Patients
Seizures
Serology
Stroke
Tomography, X-Ray Computed
Treatment Outcome
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Summary:To show the first clinically reported case of Cat Scratch Disease (CSD) presenting as a focal neurologic deficit in an immunocompetent adult. 59-year-old male with a history of a previous stroke. Examination showed an expressive aphasia, word substitution errors, and impaired repetition. A head CT and MRI showed no acute changes. The EEG findings were non-focal and did not show any epileptiform activity. The patient had a history of contact with stray kittens and previous axillary lymphadenopathy. Bartonella henselae serology titers were IgG positive 1:1024 (< 64) and IgM positive 1:20 (< 16). After antibiotic administration, the patient's symptoms and aphasia resolved. Focal presentations concerning for stroke or partial seizure activity may have underlying infectious etiology. We recommend consideration of CSD in the differential diagnosis of any adult with a history of lymphadenopathy, fever, and recent contact with a cat who presents with neurologic complications.
ISSN:0044-0086
1551-4056