The disease typically presents a fever and regional lymphadenopathy located adjacent to the inoculated site within 2 weeks after exposure to the cat. The cat is usually less than 1 year of age. The inoculated site appears as a papule 3 to 5 days after exposure and becomes vesicular and crusty. The involved lymph nodes may remain enlarged for months. Axillary lymphadenopathy is common because the hands and arms are the usual sites of inoculation. Other sites include the cervical and the inguinal regions. The histopathologic feature of the involved lymph node is a granuloma with central necrosis, infiltrating neutrophils, and lymphoid hyperplasia. The course of the disease is self-limited and seldom needs medical therapy. About 10% to 12% of the patients have unusual presentations making the diagnosis less obvious.2 Granulomatous hepatitis presenting with fever and abdominal pain, with or without lymphadenopathy, has been reported in the past.3- 4 Rare presentations of CSD include Parinaud oculoglandular syndrome, acute encephalopathy,5 osteolytic lesions,6 transverse myelitis,7 neuroretinitis, aseptic meningitis,8 thrombocytopenic purpura, atypical pneumonia, and erythema nodosum.2 Gastrointestinal manifestations of CSD may include granulomatous splenitis and appendicitis.9 Atypical presentations may mimic other serious illnesses, such as lymphoma, tuberculosis, and malignancies. If the diagnosis of CSD is not considered early on, unnecessary, extensive and costly workup may ensue.