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Progressive Cat Scratch Disease Despite Antimicrobial Therapy.

Cat scratch disease (CSD) is a zoonosis with a worldwide distribution which is frequently encountered in children. It is caused by the fastidious gram-negative bacillus Bartonella henselae, whose natural reservoir is cats. It is typically transmitted by the scratch of a kitten. The predominant manifestation in immunocompetent patients is regional lymphadenopathy. Cat scratch disease is generally a benign self-limiting disease, with spontaneous resolution of symptoms within 2–4 months in the majority of children. Although antimicrobial therapy is frequently prescribed, there is currently very limited data on whether such treatment hastens resolution of symptoms or helps to prevent further progression of disease. We describe a case of CSD in a boy who had progressive disease despite treatment with several courses of antibiotics. His complications included osteomyelitis of his skull, giving an appearance suggestive of Pott Puffy Tumor, although without sinusitis. He ultimately required surgical debridement of his frontal bone, as well as repeated incision and drainage of infected nodes. This case illustrates how CSD can progress despite antimicrobial therapy. It highlightsthe importance of close follow-up and awareness of the rare manifestations of this normally benign disease.