Surgical treatment of chronic lymphadenitis caused by Bartonella henselae

Cat-scratch disease (CSD) is a common cause of lymphadenitis in children and is usually associated with a history of cat exposure. The vast majority of CSD lymphadenitis cases resolve spontaneously, and only a few require surgical drainage. In exceptional cases, it may have an unfavorable course, for instance, with development of fistulizing lymphadenitis or a purplish exophytic mass requiring surgical treatment for resolution.

A 5-year-old female patient presented with left submandibular lymphadenitis and a history of contact with a cat. After 18 days, despite treatment with azithromycin, she developed an abscess that required drainage. Molecular testing was positive for Bartonella henselae.

Two and a half months after drainage, the patient presented with persistent lymphadenopathy and a purplish, exophytic mass, associated with persistent fever. Therefore, excision of the mass with cervical lymphadenectomy was performed, without complications. The patient developed paresis of the left orbicularis oris muscle and hypoesthesia in the left auricular region, which resolved spontaneously.

At 12 months of follow-up, the patient remained asymptomatic and free of disease.

Lymphadenitis due to CSD usually has a favorable, self-limiting course. However, surgical treatment is considered a safe and effective curative option if it progresses to fistulizing lymphadenitis or a purplish exophytic mass after more than two months.