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Archivos de Pediatría del Uruguay

versión impresa ISSN 0004-0584versión On-line ISSN 1688-1249


DEL RIO, Andrés et al. Systemic bartonellosis with hepatic and splenic lesions in immunocompetent patient: Presentation of a case and bibliography review. Arch. Pediatr. Urug. [online]. 2016, vol.87, n.2, pp.131-136. ISSN 0004-0584.

Cat Scratch Disease (CSD) is an infectious disease caused by Bartonella henselae. This disease is usually benign and the benefit of antibiotics has not been clearly proved yet. However, a few patients develop atypical forms that are more severe, with systemic involvement, such as the formation of hepatic and splenic granulomas. The study presents the case of a ten year old girl with hepatic granuloma who was seen at the Pereira Rossell Hospital Center. She consulted for prolonged fever, asthenia, abdominal pain and weight loss. Etiology was investigated and differential diagnosis was performed to suggest possible therapies. There were no serologic tests in the country at that time to be used for the etiological search, what resulted in diagnostic difficulties for this patient. At last, we obtained serologic confirmation of CSD in the patient by sending the sample to the Ricardo Gutierrez Hospital of Buenos Aires, almost one month after the initiation of symptoms. The patients was initially treated with oral Azithromycin (10 mg/kg/day) for ten days and given the slow and unsuccessful evolution, a second antibiotic plan was used, including Clarithromycin (15 mg/kg/day) and rifampicin (15 mg/kg/day) for 6 weeks. Evolution was favorable, a progressive reduction of the size of hepatic and spleen granulomas was seen. Discussion: hepatic and spleen granulomas are an unusual form of presentation of CSD, though rather an orientating one. Evidence about treatment is scarce, and it results from case series- Patients with systemic involvement may require combined and long treatments.


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