Atypical Presentation of Pediatric Cat Scratch Disease: A Case Report

Cat scratch disease is a zoonotic infection caused by Bartonella henselae and typically presents with regional lymphadenopathy and mild systemic symptoms in immunocompetent children. Atypical disseminated disease with visceral involvement is uncommon and may occur without classic clinical findings, leading to delayed diagnosis, particularly in patients with altered immune responses. We describe the case of an 11-year-old girl with type 1 diabetes mellitus who presented with persistent fever and progressive abdominal pain. Initial evaluation suggested streptococcal pharyngitis, and she was treated with appropriate antibiotics without improvement. Subsequent imaging revealed multiple hepatic lesions concerning for malignancy or infection. The patient had significant cat exposure but lacked lymphadenopathy or cutaneous lesions. Laboratory studies demonstrated anemia and elevated inflammatory markers with normal liver enzymes. Magnetic resonance imaging confirmed multifocal hepatic involvement. Based on imaging findings and exposure history, disseminated Bartonella henselae infection was suspected, and empiric antimicrobial therapy was initiated. The patient improved clinically, and serologic testing later confirmed the diagnosis. This case highlights an atypical presentation of disseminated cat scratch disease with isolated hepatic involvement in a child with diabetes mellitus. Recognition of hepatic lesions on imaging and careful exposure history were critical for diagnosis. Clinicians should maintain a high index of suspicion for Bartonella henselae in pediatric patients with prolonged fever and abdominal pain, especially those with metabolic or immunologic risk factors, even in the absence of classic features.