Retroperitoneal lymphadenopathy in cat scratch syndrome

The association of generalized lymphadenopathy, hepatosplenomegaly, fever and weakness without skin lesions in some cases of cat scratch syndrome, may lead to the erroneous diagnosis of a malignant lymphoproliferative disorder. A 24-year-old man was hospitalized due to weakness and lassitude which had started four weeks earlier and two weeks after he had been scratched by a cat. Physical examination, radionuclide studies and ultrasound examination revealed hepatosplenomegaly, bilateral axillary and inguinal lymphadenopathy and enlarged retroperitoneal and para-aortic lymph nodes. The Hanger-Rose skin test was positive and biopsy of an axillary lymph node showed typical findings of cat scratch syndrome. The patient recovered spontaneously with regression of all enlarged lymph nodes and of the hepatosplenomegaly. Enlargement of retroperitoneal lymph nodes has not yet been described in cat scratch syndrome and the incidence of retroperitoneal lymphadenopathy in this condition is not known. The newer noninvasive methods for examination of the retroperitoneal region were not available when most of the clinical studies of cat scratch syndrome were published.