29 October 2025
: Case report 
Suspected Hepatosplenic Cat Scratch Disease with No Major Symptoms and Negative Serology: A Case Report
Challenging differential diagnosis
Hanna Osawa E 1*, Koko Shibutani E 2, Nobuyoshi Mori
ADE 2
DOI: 10.12659/AJCR.949495
Am J Case Rep 2025; 26:e949495
Table 1 Diagnosis of cat scratch disease [2].
| Criteria |
|---|
| 1. Cat or flea contact with or without a scratch mark or a regional inoculation lesion (skin papule, eye granuloma, mucous membrane) |
| 2. Laboratory/radiology: negative purified protein derivative or serology for other infectious causes of adenopathy; sterile pus aspirated from node, polymerase chain reaction assay positive; Bartonella heselae, Bartonella quintana, or Afipia felis: highest sensitivity. CT scan: liver/spleen abcesses |
| 3. Positive enzyme immunoassay or indirect fluorescent antibody assay serology test >1: 64 for B. henselae or B. quintana or Baretonella clarridgeiae; 4-fold rise in titer between acute and convalescent specimens is definitive |
| 4. Biopsy of node, skin, liver, bone, or eye granuloma showing granulomatous inflammation compatible with cat-scratch disease; positive Warthin-Starry silver stain |
| Diagnosis is confirmed when 3 of 4 criteria are met; in an atypical case, all 4 criteria may be needed. |