A rural child aged eight years and four months presented with a fever of six days of evolution accompanied by pain and abdominal disfunction.
In the initial evaluation, the examination was negative, except for multiple erosions forearm, left arm and bladder, as well as pustule of approximately 0.5 cm on the external face of the left arm and left axillary adenopathy.
Initial laboratory data included leukocytosis 12,400 with 69% granulocytes, 8% monocytes, 23% lymphocytes, VSG 63 mm/h, culture of blood and feces negative, tuberculin skin test normal PPD urine.
Keep feverish peaks daily.
Once the fever was suspected, treatment was started with the usual dose of the medication, which was suspended six days later due to the negativity botorii serology.
The patient continues to present fever peaks, and new negative hepatitis viruses were programmed, revealing a normal leukocyte count, ESR 92 mm/h, normal cytomorphology, PCR 3 mg/dl, normal liver tests, and Bruglutin
Abdominal ultrasound reveals the presence of multiple hypoechoic images, the largest of them 6 mm, at the level of the spleen and in the liver a similar single image of 5 mm in diameter.
Contrast-enhanced abdominal CT corroborates the findings and confirms the possibility of diagnosis of microabscesses or Cat Scratch Disease; Bartonella Henselae is requested with confirmation of serology,
persistent fever peaks and abdominal pain is replaced by rifampicin plus rifampin, with a total duration of 28 days after initiating treatment showing clinical improvement and disappearance of fever.
