A 50-year-old woman with a history of polyarthralgia and chronic active smoking.
She presented with a 2-month history of persistent fever, night sweats, weight loss, polyarthralgia in the lower limbs, and increased sensitive right cervical volume.
A history of a sister with KFD and direct contact with cat.
She was admitted to the emergency department with cervical ultrasound showing multiple right cervical lymph nodes.
She was prescribed amoxicillin-clavulanic acid for 5 days without clinical improvement and was hospitalized.
Physical examination revealed right cervical adenopathy of 5 x 6 cm, sensitive and without visceromegaly.
Blood count showed ESR of 56 mm/h and CRP and ferritin were 77 mg/L and 1,789 ng/mL, respectively.
CT scan of the neck, chest, abdomen and pelvis, in addition to finding cervical and mediastinal lymph nodes, revealed ground-glass pulmonary opacities.
In parallel, HIV, EBV, CMV, hepatitis B and C virus, syphilis and Toxoplasma gondii were ruled out.
The IgM for Bartonella hensenlae was negative, while IgG was positive (1/64).
Lipids were prescribed daily for 6 days without response.
The immunological study was practically normal, with only a low positive ANA (1/40).
A biopsy of the cervical adenopathy was performed.
Bacteria and necrotizing lymphadenitis were negative, while the histological study revealed histiocytic necrotizing lymphadenitis.
Prednisone 30 mg daily was started for three weeks with progressive dose reduction completing 45 days of therapy.
Symptoms disappear within 48 hours of treatment.
Two months later, the patient was monitored with a chest CT scan that reported an increase in ground glass images.
A lung biopsy revealed findings consistent with usual interstitial pneumonia in the late phase.
At 6 months of follow-up she had no respiratory symptoms or significant changes in lung function tests.
