A 9-year-old girl with cat-scratch disease complicated by encephalopathy and seizures is reported from the Kaiser Foundation Hospital, Los Angeles, CA. The patient was admitted to hospital after a 2-week history of cervical adenitis, a 2-day history of low-grade fever, diarrhea, and headache, and an 11-day course of oral antibiotics with no response. A generalized tonic-clonic seizure occurred within hours of admission and initiation of i.v. antibiotics. Following the 2 minute seizure she became combative, delirious, and comatose. CSF showed protein of 72 mg/dl and normal cells. Recovery began after 24 hours and was complete in 5 days. Serum serology and polymerase chain reaction (PCR) analysis of lymph node tissue were positive for Bartonella henselae. The child had 4 kittens but no observed scratches or bites. [1]

COMMENT. Neurologic complications of cat-scratch disease are uncommon, although there are several reports of encephalopathy, generally with complete recovery, and isolated reports of myelopathy, cranial nerve palsies, optic neuritis, chorea, and cerebellar ataxia. A cat scratch is not always identified, but the cat is the principal reservoir for the infecting organism, Bartonella henselae. A cat flea may account for the transmission in some cases. See Progress in Pediatric Neurology II (Millichap JG, ed. Chicago, PNB Publishers, 1994;pp421-423) for further reports of neurologic complications of cat-scratch disease, including one series of 76 patients. The differential diagnosis includes Lyme encephalitis.