Hepatosplenic Cat Scratch Disease: Description of Two Cases Undergoing Contrast-Enhanced Ultrasound for Diagnosis and Follow-Up and Systematic Literature Review

Abstract

Cat scratch disease (CSD) is a disease usually characterized by self-limited lymphadenopathy of the young man. Rarely CSD, however, can manifest itself as an unusual hepatosplenic form (HS-CSD) in immunocompetent patients. HS-CSD diagnosis is generally based on clinical features, imaging, and serologies, but sensitivity of serologies is very variable, like that of other diagnostic methods, as Warthin-Starry silver stain and isthology. Also there are no specific markers for the follow-up. The use of the CEUS (abdominal contrast-enhanced ultrasound) in HS-CSD is not previously described in literature examined, but we think that CEUS can be of help to diagnosis and follow-up of these patients, even after an initial CT scan, because it is a sensitive method, as seen in other diseases associated with granulomas, such as sarcoidosis. We describe 2 new cases of HS-CSD, and we performed a systematic review of the clinical cases reported in the past 10 years in the literature associated to an analysis of clinical, diagnostic, and therapeutic aspects of the disease.

Keywords: Abdominal contrast-enhanced ultrasound; Cat scratch disease; Diagnosis; Follow-up; Hepatosplenic cat scratch disease; Immunocompetent patient.

Fig. 1

CEUS of patient 1. Spleen, arterial phase: nodular splenic lesions without arterial wash-in and without venous wash-out

Fig. 2.1

CEUS patient 2. Left liver, arterial phase: nodular liver lesions with peripheral arterial wash-in and without venous wash-out

Fig. 2.2

One month later. CEUS of patient. Liver and spleen, arterial phase. New nodular lesion without arterial wash-in and without venous wash-out in VII segment

Fig. 2.3

CEUS of patient, six months later. Liver and spleen, arterial phase. Resolution of nodular lesion

Fig. 3

Abdomen CT of patient 2. Liver and splenic lesions

Fig. 4

Lymphnode cytology: small size lymphocytes mixed with mononuclear large size and histoepithelioid microgranulomas