Progressive lymphadenopathy and intractable pain in an immunocompetent African-American adult with cat-scratch disease.

Persistent, painful cervical lymphadenopathy associated with malaise that does not respond to oral antibiotics may be cat-scratch disease. This condition is challenging to treat and may require surgical intervention. We present a case report of an immunocompetent 47-year-old African-American woman who was diagnosed with cat-scratch disease and hospitalized after multiple outpatient evaluations for progressive, painful lymphadenopathy. This case report outlines the patient's treatment in the author's urban outpatient clinic followed by an inpatient hospital stay with surgical intervention. Although the reported incidence of cat-scratch disease is higher in whites, primary care physicians should include cat-scratch disease in their differential diagnosis for African-American patients with regional lymphadenopathy, which is a hallmark of the disease. In addition, primary care physicians should be familiar with the atypical presentations of cat-scratch disease and the broad differential diagnosis for regional lymphadenopathy, including sarcoidosis, which is more common in African Americans.