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Case 126 - Discussion

Uploaded: 2010-08-04, Updated: 2010-08-04

Cat-Scratch Lymphadenitis

  • Necrotizing granulomatous lymphadenitis caused by Bartonella henselae

  • Healthy individuals -benign, self-limited illness, lasting 6-12 weeks without treatment; AIDS - disseminated or fatal

  • Micro:

    • Necrotizing granuloma

    • Central microabscesses with neutrophils

    • Peripheral palisaded epithelioid cells

    • Capsular and perinodal involvement

    • Clumps of pleomorphic bacillary bacteria, positive for Warthin-Starry silver stain

  • DDX:

    • Suppurative lymphadenitis: abscess formation with positive Gram's stain

    • Lymphogranuloma venereum: similar morphology, often impossible to differentiate, IFA and serology necessary

    • Kikuchi necrotizing lymphadenitis: patchy necrosis, abundant nuclear debris, lack of neutrophils or epithelioid cells with granulomatous arrangement. C-shaped histiocytes and immunoblasts. Negative for Gram's stain or Warthin-Starry stain.

Reference: Ioachim's Lymph Node Pathology, 4th edition