https://escholarship.org/uc/item/2f31g4pv (Pictures of the granulomas in link)
Erythema nodosum and sarcoid granulomas — letting the cat out of the bag
Authors: Morgado, Francisca; Batista, Mariana; Courtinho, Ines; Cardoso, Jose Carlos; Tellachea, Oscar
A 41-year-old woman presented with a violaceous papule on the dorsum of the hand, large ipsilateral axillary lymphadenopathy, and tender, erythematous, subcutaneous nodules on the legs. Accompanying signs included fever, ankle swelling, and bilateral red eye. She recalled having a previous exposure to kittens one month before and had a positive family history for sarcoidosis. Histological examination of the hand lesion showed sarcoidal granulomas with positive Bartonella henselae DNA, whereas a biopsy done on the leg nodules was compatible with erythema nodosum. Cat scratch disease (CSD) typically presents as a tender regional lymphadenopathy preceded by an inoculation papule with spontaneous resolution occurring between 8-16 weeks. Cutaneous manifestations of CSD are rare, with erythema nodosum accompanying only 0.6% of cases. Although speculative, the background of a positive family history for sarcoidosis may explain the atypical presentation of this case, with red eye, persistent arthralgia, and associated sarcoidal granulomas.
There is so much yet to be discovered about Bartonella. Nearly every Lyme/MSIDS patient I know struggles with it. It is far more pervasive and serious than mainstream researchers and doctors know. They’ve always attributed Bartonella infection with a compromised immune function and cat exposure, yet infection in completely healthy people without cat exposure occurs: https://madisonarealymesupportgroup.com/2019/01/23/chest-imaging-of-cat-scratch-disease-in-2-year-old-immunocompetent-baby-with-no-history-of-cat-contact/
https://madisonarealymesupportgroup.com/2018/07/10/bartonella-henselae-neuroretinitis-in-patients-without-cat-scratch All the patients denied a history of a cat or any animal contact, or of having CSD findings.
https://madisonarealymesupportgroup.com/2018/07/05/cat-scratch-disease-in-a-1-5-year-old-girl-case-report/ Healthy 1.5-year-old girl who was seen in hospital for the sparing use of her left arm when crawling. Tested positively for Bartonella henselae.
https://madisonarealymesupportgroup.com/2018/04/03/encephalopathy-in-adult-with-cat-scratch-disease/ Case of a 53-year-old healthy man, presenting with confusion. Serology confirmed Bartonella henselae infection.
https://madisonarealymesupportgroup.com/2019/01/09/transverse-myelitis-guillain-barre-associated-with-bartonella/ Healthy 10 year old girl had coexisting transverse myelitis and Guillain-Barré syndrome (GBS) related to infection with Bartonella henselae.
https://madisonarealymesupportgroup.com/2018/11/05/skull-infection-due-to-bartonella/ While cats are implicated, this 3 year old had no significant medical history, presented at emergency department for a 2-week history of worsening scalp lump with redness.
https://madisonarealymesupportgroup.com/2018/03/04/bartonella-erythema-nodosum-atypical-presentations/ All immunocompetent hosts.