A Serological Test Negative Case of Suspected Cat Scratch Disease with Fever and Lymphadenopathy Detecting by Gallium Planar and SPECT Scan: A Case Report and Discussion

疑似貓抓病合併發燒與淋巴腺病變但血漿陰性病例之鎵發炎掃描與單光子斷層攝影偵測：病例報告與討論

門朝陽(Chao-Yang Men) ； 沈淑禎(Shu-Jane Shen)

《核子醫學雜誌》 22卷3期 (2009/09) Pp. 189-194

https://doi.org/10.6332/ANMS.2203.007

摘要

貓抓病是一種人畜共通傳染病，症狀從非常輕微的局部疾病（典型）到嚴重散佈的全身疾病（非典型）都有，不過患者卻不會再傳播他人。這個新的人畜共通傳染病於1998年臺灣提出首例報告。大部份患者都有在家中養貓，有時是否有被貓咬或抓傷，患者本人也不是很確定，但患者多會注意到自身有摸的到或腫脹的林巴腺。我們提出一個非常疑似有貓抓傷的40歲女性成年人，在疑似貓抓傷復數日發生腋下與手肘淋巴腺腫痛並反覆發燒，因診所治療無效而求助急診並住院九日打抗生素治療才退燒出院的案例。患者在住院期間安排鎵發炎掃描加單光子斷層攝影，顯示右腋與手肘淋巴腺病變，此症狀與臨床病史一致，但是血漿檢體卻呈現陰性。藉由本例提醒我們，鎵發炎掃描也可以當作貓抓病的例行掃描，可用於兒童，免疫抑制患者甚至於健康的成年人身上作診斷。但有許多疾病在影像診斷上與貓抓病相似，因此需要臨床實驗數據與病史來作區分此病的變異性。依據衛生署疾病管制局通報記錄，在2007年確定貓抓病有12例，而2008年則有8例。由於診斷率不高，我們寄望於更新的血漿聚合酶連鎖反應(polymerase chain reaction; PCR)技術能應用於提高貓抓病的診斷敏感度。

關鍵字

貓抓病 ； 淋巴腺病變 ； 鎵掃描 ； 聚合酶連鎖反應

並列摘要

Cat-scratch disease is an infectious disease ranging from very mild localized disease to severe dissiminated disease but self limited and is not contagious to others. This new zoonotic disease was first reported in Taiwan in 1998. Most of them had history of cat feeding at home. The history of cat bite or scratch is not always clear even when the patients themselves are asked. Palpable swollen lymph nodes are usually noted by the patient. We report an adult woman who had a definite history of being scratched by a cat and then developed ipsilateral axillary and elbow painful lymph nodes swelling associated with fever. The cat scratched site is beneath the right elbow region. Then, she was hospitalized for nine days for antibiotic therapy. During admission period, she was surveyed with gallium scan and SPECT. The focally involved lymph nodes are well demonstrated by scintigraphy in right axillary and elbow lymph nodes. The findings were well correlated with clinical history and symptom. This reminds us gallium inflammatory scan could be a routine scan and is helpful for the diagnosis of cat scratch disease, especially for children or immune system suppressed patients or even for normal healthy adults. Diseases mimicking cat scratch disease in imaging diagnosis are diverse and further clinical laboratory and history reviews are very important for differentiation because of variations. Serum antibody study of this case is negative though Bartonella henselae is the most cause of this disease, there are other rare causes to our knowledge. So, we attribute this case to be a suspicious case of cat scratch disease because it does not meet the at least three of four criteria of cat scratch disease. According to the reports of the Center for Disease Control (CDC) reports for cat scratch disease in Taiwan, there were only 12 and 8 proven true positive cases in 2007 and 8 cases in 2008, respectively. Since the diagnostic rate of CSD is not high, so we expect new polymerase chain reaction (PCR) technology could be used to increased the sensitivity for the diagnosis of CSD.

並列關鍵字

cat scratch disease ； lymphadenopathy ； gallium scan ； polymerase chain reaction