Journal of ultrasound · 2026
Ultrasound features of visceral cat scratch disease: a rare case of granulomatous hepatosplenic bartonellosis in an immunocompetent patient.
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Russo Giorgia, Biasini Elisabetta, Missale Gabriele
Аннотация
OBJECTIVE: To describe the pivotal role of conventional B-mode and contrast-enhanced ultrasound (CEUS) in identifying and characterizing rare visceral manifestations of Bartonella henselae infection in an immunocompetent individual.
CASE REPORT: A 67-year-old immunocompetent female presented with a diffuse maculopapular exanthema, fever, and left inguinal lymphadenopathy following a cat scratch. Conventional ultrasound revealed multiple subcentimetric hypoechoic areas in both hepatic lobes and the spleen, along with a necrotic-colliquative nodal mass in the left Scarpa's triangle. CEUS demonstrated an inflammatory/necrotic perfusion pattern characterized by absence of contrast enhancement, appearing as avascular, non-enhancing necrotic cores suggestive of granulomatous lesions. The clinical suspicion was confirmed by positive Bartonella henselae serology. Clinical resolution was achieved after a 1-month course of doxycycline.
CONCLUSIONS: Visceral cat scratch disease should be considered in the differential diagnosis of multiple hepatosplenic lesions even in fully immunocompetent hosts. Multiparametric ultrasound, particularly CEUS, represents an essential, non-invasive standard tool for early detection, definitive characterization, and radiation-free therapeutic monitoring.
CASE REPORT: A 67-year-old immunocompetent female presented with a diffuse maculopapular exanthema, fever, and left inguinal lymphadenopathy following a cat scratch. Conventional ultrasound revealed multiple subcentimetric hypoechoic areas in both hepatic lobes and the spleen, along with a necrotic-colliquative nodal mass in the left Scarpa's triangle. CEUS demonstrated an inflammatory/necrotic perfusion pattern characterized by absence of contrast enhancement, appearing as avascular, non-enhancing necrotic cores suggestive of granulomatous lesions. The clinical suspicion was confirmed by positive Bartonella henselae serology. Clinical resolution was achieved after a 1-month course of doxycycline.
CONCLUSIONS: Visceral cat scratch disease should be considered in the differential diagnosis of multiple hepatosplenic lesions even in fully immunocompetent hosts. Multiparametric ultrasound, particularly CEUS, represents an essential, non-invasive standard tool for early detection, definitive characterization, and radiation-free therapeutic monitoring.