A 5-year-old girl presented to the emergency department with a preauricular mass and submandibular adenopathy on the left side of her face that had been visible for 2 months. An excoriation below the left eye (Panel A, red arrow), a fluctuant, tender preauricular mass (Panel A, blue arrow; and Panel B), and submandibular adenopathy (Panel A, black arrow) were observed on physical examination. The patient had no history of fevers, and her vision was unaffected. She frequently played with a cat at home. The preauricular mass was aspirated, and a purulent, brownish drainage was obtained. Given the high clinical suspicion of cat scratch disease, the patient was discharged with a 5-day prescription for oral azithromycin. The results of culture of the aspirate in chocolate agar were negative, but histopathological analysis of the aspirate revealed an inflammatory infiltrate with necrosis. Bacilli were detected on Warthin–Starry staining. Serologic tests were positive for the causative bacterium, Bartonella henselae (IgM titer, >1:1024; IgG titer, >1:20). Parinaud’s oculoglandular syndrome, a manifestation of cat scratch disease, is characterized by involvement of the conjunctiva or the area around the eye, in association with preauricular lymphadenitis on the same side. The syndrome can occur when the inoculation site involves the conjunctiva or eyelid. On follow-up 2 months after treatment, the patient’s preauricular and submandibular adenopathy had resolved.
Catalina Arango-Ferreira, M.D.
Jorge Castano, M.D.
Universidad de Antioquia, Medellín, Colombia