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John R. Black, MD; Deirdre A. Herrington, MD; Ted L. Hadfield, PhD; Douglas J. Wear, MD; Andrew M. Margileth, MD; Brian Shigekawa, PhD

Arch Intern Med. 1986;146(2):394-396.

Abstract
• We describe a renal allograft recipient with cat-scratch disease in whom refractory hypotension, severe metabolic acidosis, pulmonary infiltrates, and encephalopathy developed. The patient first presented with a history of cat bites and scratches, fever, headache, and arthralgias. Four weeks later, the clinical presentation of septic shock suddenly developed in the patient. Cat-scratch disease was documented clinically and by finding delicate pleomorphic bacilli in Warthin-Starry silver stains of biopsy specimens taken from the primary inoculation site and regional lymph node. The administration of intravenous sulfamethoxazole and trimethoprim, erythromycin lactobionate, and tobramycin sulfate therapy correlated with recovery. Although cat-scratch disease is usually a benign, self-limited illness, this article illustrates its systemic nature, its potential for devastating complications in the immunocompromised host, and its possible response to vigorous antibiotic therapy.

(Arch Intern Med 1986;146:394-396)

Author Affiliations
From the Department of Medicine, University of North Carolina, Chapel Hill (Drs Black and Herrington), the Armed Forces Institute of Pathology, Washington, DC (Drs Hadfield and Wear), the Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Margileth), and the Becton-Dickinson Co, Research Triangle Park, NC (Dr Shigekawa). Dr Black is presently with the Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis.

Footnotes
Accepted for publication July 3, 1985.

The views expressed herein are those of the authors and are not to be construed as official, or as reflecting the views of the US Air Force, US Army, or the Department of Defense.

Reprint requests to the Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Emerson Hall, Room 435, 545 Barnhill Dr, Indianapolis, IN 46223 (Dr Black).

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