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A 5 year old girl presents with a 2 cm tender lump in her right armpit. It is not fluctuant and there is no overlying redness. On history, she has a kitten, and did sustain scratches to her right hand from the kitten in the last few weeks. She had a small papule on her hand in an area of a scratch 1.5 weeks ago that mom thought was a bug bite. Parents are unsure if she has had any fevers. She is otherwise healthy and well appearing.
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October 30, 2018 at 3:44 pm
E) Ciprofloxacin
Regional lymphadenopathy is the most common presentation of cat scratch disease in children. Higher risk cats include young cats under age 1 year, and possibly, stray cats. Patients may or may not have an “inoculation lesion” that is vesicular or popular 3-10 days after the cat exposure. Lymphadenopathy develops about 2 weeks later, typically in the nodes draining the area scratched. Axillary, epitrochlear, and head & neck nodes are commonly affected. Nodes are often tender, 1-5cm in diameter, may have overlying erythema, and 10-15% suppurate. Antibiotic therapy in healthy children with simple lymphadenopathy / adenitis is controversial. There is some evidence that Azithromycin results in more rapid resolution and may help prevent complications. Other antibiotics such as penicillins, tetracyclines, cephalosporins, TMP-SMX, fluoroquinolones and Rifampin may be used. Doxycycline has traditionally been contraindicated in children < 8yo if other alternatives are available, due to the possibility of teeth discoloration with tetracyclines. Recent evidence shows that doxycycline, unlike tetracycline and minocycline, does not cause tooth staining (https://www.jpeds.com/article/S0022-3476(15)00135-3/fulltext). Fluoroquinolones, however, are not recommended for children < 18 years of age if other alternatives exist, due to risk of arthropathy and cartilage erosion in weight-bearing joints.