Cat-scratch disease mimicking soft tissue sarcoma in a pediatric patient

Abstract

Cat scratch disease, first described in France in the 1930s, is a benign infectious disease with often atypical presentation. Its clinical symptoms and radiologic features can overlap with those of a sarcoma. Here we present the case of a 12-year-old female with cat-scratch disease that was initially misdiagnosed as a soft tissue sarcoma of the elbow. The patient was then successfully treated with an antibiotic course. Our case emphasizes the importance of early consultation by a specialized multidisciplinary team given the lack of specificity and overlap of presentation among benign and malignant masses.

Keywords: Cat-scratch disease; Pediatric; Sarcoma mimicker.

Fig. 1

Clinical picture of the patient's elbow indicating the location of the mass as well as its associated skin discoloration.

Fig. 2

Radiographs of the right elbow, anteroposterior and lateral views, demonstrating increased density of the soft tissues on the medial aspect.

Fig. 3

CT-scan of the elbow with axial views of soft tissue and bone windows showing the presence of a mass on the medial aspect with no abnormalities of the distal humerus.

Fig. 4

MRI with and without contrast of the elbow, axial, coronal and sagittal views of the T1-fat suppressed post contrast sequence, demonstrating the mass in further detail with areas of necrosis and enhancing central nodule. The mass is abutting the ulnar nerve.

Fig. 5

Microscopic image H&E × 10 (A) and × 40 (B) of the lesion demonstrating necrosis and inflammatory infiltrate as well as poorly organized histiocytic granulomas.