Isolated Axillary Lymphadenitis Due to Bartonella Infection in an Immunocompromised Patient
Bartonella henselae is a relatively uncommon pathogen that can present as a serious disease in immunocompromised patients. We present a case of a 76-year-old man with stable chronic lymphocytic leukemia (CLL) who presented to the emergency department (ED) with an onset of right axillary lymphadenitis after recovering from a recent cat bite on the ipsilateral finger. Doppler ultrasound demonstrated an irregular, circumscribed 5cm x 4cm, hypoechoic mass with mild vascular flow consistent with an enlarged abnormal lymph node. The patient was diagnosed with cat scratch disease and discharged on oral antibiotics with spontaneous drainage of the purulent materials in subsequent outpatient oncology visits. This case highlights the classic presentation of this rare disease in an immunocompromised patient with feline contact. Early antibiotics should be considered for at-risk and immunocompromised patients due to low sensitivity and specificity for Bartonella serologic tests. CLL can also present with similar progressive lymphadenopathy with severe systemic symptoms and extranodal involvement that requires emergent oncologic interventions and diagnostic vigilance.
Bartonella is NOT rare.
In this article, Dr. Mozayeni talks about Bartonella being one of the major co-infections of Lyme disease. It’s even more prevalent than Lyme, as there are many more ways to contract the disease (eg. flees, cats). In a study, that Dr. Breitschwerdt and Mozayeni published in The Journal of Emerging Diseases, about 60% of Lyme patients tested positive for Bartonella: https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/ If you want to know the likelihood of infection, please see the checklist within the article. Print it out and check how many symptoms you have. Take this with you to your doctor appointment and discuss the likelihood.
I’m glad this research article points out that testing is poor. This is true of each and every test for tick borne illness. This requires an educated and experienced practitioner to discover what patients are infected with. If you have tick borne illness, save your time and money and get to an ILADS trained doctor.
In my experience, I’ve found Bartonella to be harder to deal with than Lyme disease.