An 18-year-old female young adult with seizures associated with cat scratch disease is reported from Norwalk Hospital, Yale University School of Medicine, CT. She presented with difficulties in speaking followed by generalized tonic-clonic seizures and continuous right facial motor seizures refractory to antiepileptic drugs. Audio-video EEG monitoring revealed the epilepsia partialis involving the right lower face and occasionally, the tongue and larynx, without surface EEG abnormalities. MRIs were initially normal, and later showed an increased signal on T2-weighted images in the left frontoparietal region. SPECT also showed a focus of increased activity in the same region. The patient had a new kitten at home and cat scratch disease (CSD) serology for Bartonella henselae was positive at a titer of 1:256 (cut off <1:64). Ehrlichia and Lyme serology were negative. Significant improvement in symptoms occurred within 3 weeks of starting antibiotic therapy, and a repeat CSD titer was 1:128. After 1 year follow-up and gradual tapering of antiepileptic drugs the patient remains seizure-free. Brain MRI and SPECT are now normal. [1]
COMMENT. Encephalopathy and seizures are an unusual presentation of cat scatch disease, and symptoms may be delayed for several weeks after the kitten scratch or bite. Diagnosis is dependent on the history of kitten exposure and positive serology. Spontaneous recovery usually occurs after several days without the need for antibiotics. In the present case, symptoms persisted for several weeks and recovery was prompt only after antibiotics were initiated. The differential diagnosis includes Lyme encephalitis which may occur concurrently. (See Progress in Pediatric Neurology II pp 421-423, for review of 4 previous articles on neurologic complications of cat scratch disease.