bartonella

This patient has cervical and preauricular adenopathy as well as unilateral conjunctivitis. Given the history of kitten exposure, she most likely has oculoglandular syndrome (Parinaud syndrome), a specific manifestation of cat-scratch disease (CSD). CSD is caused by infection due to Bartonella henselae, a small gram-negative rod carried by cats, especially kittens. Human transmission most commonly occurs through a cat bite or scratch, although many patients do no remember the exact point of contact.

CSD typically presents with lymphadenitis and is the most common cause of chronic (>2 weeks), unilateral adenitis in children. Since bites and scratches usually occur on the extremities, ipsilateral axillary or inguinal node involvement is most common. However, when the inoculation is near the face, adenopathy of the preauricular or cervical nodes is seen. Involvement of the conjunctivae (as in this case) is an uncommon but characteristic presentation of CSD.

Symptoms typically self-resolve within a couple of months; however, in some cases, lymph nodes will suppurate and drain onto the skin. Treatment with azithromycin can help accelerate recovery, and needle aspiration may prevent overt rupture and relieve symptoms; lymph node excision is not indicated.