Ultrasound features of visceral cat scratch disease: a rare case of granulomatous hepatosplenic bartonellosis in an immunocompetent patient

Abstract 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.