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Question: fever

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You are seeing an 8 year old girl with fever of unclear etiology for 7 days. She is well appearing. Exam reveals 1-2cm tender nodes in her left axilla and left anterior cervical areas. She has a superficial healing scratch on her left forearm, and history reveals that she has been spending time at a cousin’s house with the cousin’s new kitten. She is also noted to have hepatomegaly 2cm below the right subcostal margin, and a palpable spleen tip. She has no petechiae or purpura. The remainder of her exam is noncontributory. 

Which is the best treatment for her presumed condition?

pemsou5_wp • March 28, 2023

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  1. Kelly March 28, 2023 - 4:28 pm Reply

    B) Azithromycin
    Cat scratch disease commonly presents with regional tender lymphadenopathy of the nodes that drain the inoculation site. The etiology is thought to be Bartonella henselae from a scratch or bite by an infected cat; kittens and cats with fleas are higher risk. It may also present as fever of unknown origin. Less commonly there may be hepatosplenomegaly, oculoglandular syndrome (red watery eyes), neurologic and musculoskeletal symptoms. Cat scratch disease is treated by a course of azithromycin. Alternatives to macrolides include rifampin, trimethoprim-sulfamethoxazole, and for adults, ciprofloxacin.

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