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Nidhi Sharma, Unknown Case #6 Diagnosis: Bartonella (Cat Scratch Disease), Journal of Breast Imaging, Volume 2, Issue 3, May/June 2020, Pages 285–286, https://doi.org/10.1093/jbi/wbz052
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Extract
Part 2
History
A 67-year-old man presented with a palpable lump in the left axillary tail for 2 weeks. There was no associated fever, chills, or overlying redness. Diagnostic left breast mammography and ultrasound were performed for further assessment of the palpable lump (Figure 1).
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Diagnosis: Bartonella (cat scratch disease)
On mammography, there was a focal asymmetry in the upper outer left breast corresponding to the palpable area (Figure 1A). Ultrasound of the targeted site showed an irregular hypoechoic mass in the left axillary tail (Figures 1B and C) with lymphadenopathy. Ultrasound-guided biopsy of the mass revealed soft tan-yellow tissue with necrotizing granulomatous inflammation. A Warthin-Starry stain showed rod-shaped bacilli consistent with Bartonella henselae. Acid fast bacilli and Gram stain testing showed no evidence of acid fast bacilli or fungal elements.
The differential diagnosis of the imaging findings includes breast cancer, abscess, sarcoma, lymphoma, and chronic granulomatous inflammation. Abscess is a less likely differential diagnosis because the patient presented with no systemic symptoms such as fever, chills, malaise, overlying warmth, or redness. Also, there was no prior history of surgery at that site, making scar or fibrosis less likely. The patient had adopted a kitten 2 months before the onset of symptoms.
