A 6-YEAR-OLD boy complained of evening fevers, with a temperature of 38.9°C to 39.4°C and diffuse abdominal pain for 9 days. He denied any chills, vomiting, or change in bowel habits or appetite. The patient lived with his mother and two brothers in a trailer home with well water. He denied any exposure to pets. Physical examination revealed a diffusely tender abdomen with bilateral inguinal and cervical adenopathy. Ultrasonography and a computed tomographic scan of the abdomen confirmed both liver and spleen abscesses. A splenectomy and liver biopsy were performed, and histologic sections of the liver (Figure 1 and Figure 2) and spleen (Figure 3 and Figure 4) are shown below.
Diagnosis and Discussion
Systemic Cat-scratch Disease
After an extensive workup for bacterial, viral, and fungual sources, a diagnosis of systemic catscratch disease