Cat scratch disease presenting as fever of unknown origin is a unique clinical syndrome

Michal Landes, Yasmin Maor, Diego Mercer, Zohar Habot-Wilner, Efraim Bilavsky, Bibiana Chazan, Regev Cohen, Daniel Glikman, Jacob Strahilevitz, Michal Katzir, Vladislav Litachevsky, Rimma Melamed, Alex Guri, Hila Shaked, Odelya Perets, Yonit Wiener-Well, Anat Stren, Michal Paul, Oren Zimhony, Isaac SrugoGalia Rahav, Jihad Bishara, Amir A. Kuperman, Ronen Ben-Ami, Moshe Ephros, Michael Giladi

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background. Fever of unknown origin (FUO) is a rare manifestation of cat scratch disease (CSD). Data regarding CSD-associated FUO (CSD-FUO), particularly in adults, are limited. We aimed to study disease manifestations and long-term clinical outcome. Methods. A national CSD surveillance study has been conducted in Israel since 1991. Data are obtained using questionnaires, review of medical records, and telephone interviews. FUO was defined as fever of ≥14 days without an identifiable cause. CSD-FUO patients were identified in the 2004–2017 CSD national registry. Follow-up included outpatient clinic visits and telephone/e-mail surveys. Results. The study included 66 CSD-FUO patients. Median age was 35.5 years (range, 3–88). Median fever duration was 4 weeks (range, 2–9). Relapsing fever pattern was reported in 52% of patients, weight loss in 57%, and night sweats in 48%. Involvement of ≥1 organs occurred in 59% of patients; hepatosplenic space-occupying lesions (35%), abdominal/mediastinal lymphadenopathy (20%), ocular disease (18%), and multifocal osteomyelitis (6%) were the most common. Malignancy, particularly lymphoma, was the initial radiological interpretation in 21% of patients; 32% underwent invasive diagnostic procedures. Of the 59 patients available for follow-up (median duration, 31 weeks; range, 4–445), 95% had complete recovery; 3 patients remained with ocular sequelae. Conclusion. This is the first attempt to characterize CSD-FUO as a unique syndrome that may be severe and debilitating and often mimics malignancy. Relapsing fever is a common clinical phenotype. Multiorgan involvement is common. Recovery was complete in all patients except in those with ocular disease.

Original languageEnglish
Pages (from-to)2818-2824
Number of pages7
JournalClinical Infectious Diseases
Issue number11
StatePublished - 31 Dec 2020

Bibliographical note

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© The Author(s) 2019.


  • Bartonella henselae
  • Cat scratch disease
  • Fever of unknown origin


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