Cat scratch, an important disease that causes febrile syndrome

Background: Cat scratch disease is a common infectious disorder caused by Bartonella henselae that is transmitted primarily by kittens. It typically exhibits a benign and self-limiting course of subacute regional lymphadenopathy and fever lasting two to eight weeks. The most severe complication of cat scratch disease is the involvement of the nervous system, such as encephalitis, meningitis, and polyneuritis. Peripheral facial nerve palsy associated with Bartonella infection is rare; few reported pediatric and adult cases exist and the precise pathogenesis is unknown.

Case report: We present the clinical case of a 4-year-old girl who presented a clinical picture of 18 days of evolution characterized by fever of up to 39 degrees, adenopathy of inflammatory characteristics at the right supraclavicular level and in the last days of illness, facial paralysis was associated peripheral (Bell's palsy). After multiple management procedures were established, including corticosteroids and antibiotics, the girl did not show improvement with the diagnostic impression of prolonged febrile syndrome without apparent cause. Re-questioning the mother confirms exposure to cats. After laboratory analysis Bordetella Quintana infection is confirmed. This is a disease of the zoonosis group that can be caused mostly with B. Henselae.

Conclusions: The suspected granulomatous lesion was considered to have resulted from the host’s immune reaction to Bartonella infection and impaired the facial nerve. This is the first case report providing direct evidence 
of peripheral facial nerve palsy caused by a suspected granulomatous lesion associated with cat scratch disease and its treatment course.