Een man met buikpijn, gewichtsverlies en koorts

A 42-year-old man was admitted with acute progression of existing upper abdominal pain, without nausea or vomiting. He also complained of fever, nocturnal sweating and 11 kg weight loss. Ultrasound of the abdomen showed a large retroperitoneal mass and multiple small hypoechogenic lesions in the liver and spleen. A lymphoreticular malignancy was considered. Biopsy of a retroperitoneal lymph node revealed a necrotising granulomatous infection. To identify a cause of the necrotising granulomatous lymph node changes, numerous serological investigations were carried out. Serology for Bartonella henselae was positive, and disseminated cat scratch disease was diagnosed. The patient kept a number of cats. Treatment with doxycycline was started and his symptoms disappeared completely. During follow-up, ultrasound examination showed a decrease of the retroperitoneal lymph node enlargement. In approximately ten percent of B. henselae infections there is an atypical clinical presentation. This patient had a marked dissemination to the liver, spleen and retroperitoneal lymph nodes.