Abstract: The finding of lymphadenopathy is usually the consequence of a benign infection, although a neoplastic origin must always be excluded. Through a careful anamnesis, physical examination,and serological tests several differential diagnoses are frequently possible. Nevertheless, sometimes an excisional biopsy of superficial lymph nodes is required, which is the best means to reach a definitive diagnosis. More concerns arise when lymphadenopathy is only abdominal/retroperitoneal: percutaneous biopsy is often inconclusive and the excisional node biopsy becomes a surgical procedure, certainly indicated in case of malignancy but avoidable in case of inflammatory diseases. We present the case of a 30-year-old man with a deep iliac lymphadenopathy who was evaluated at the Hematological Unit of Sapienza University of Rome. The enlargement of an iliac lymph node is quite unusual for an infectious disease. Although symptoms such as pain, fever, and chills suggested it was the case, cat-scratch disease was not hypothesized. Radiological investigations did not exclude a malignant disease and a laparoscopic excisional biopsy was scheduled, but the slight improvement of his spontaneous symptoms suggested a careful follow-up. Given the lack of disappearance of lymphadenopathy, the lack of diagnosis, and an ipsilateral superficial (inguinal) lymph node with similar ultrasonographic and radiological features, the patient underwent biopsy, which disclosed a diagnosis of cat-scratch disease, avoiding more invasive surgical procedures.

Abdominal lymphadenopathy: hypothesize cat-scratch disease and avoid abdominal excisional biopsy / Filipponi, Valeria; Trasarti, Stefania; Maccioni, Francesca; Zippi, Maddalena; Busato, Ludovica; Arienzo, Francesca; Biglietto, Mario; Saullo, Paolina; Giordano, Carla; Caronna, Roberto. - In: HEMATO. - ISSN 2673-6357. - 3:4(2022), pp. 771-778. [10.3390/hemato3040052]

Abdominal lymphadenopathy: hypothesize cat-scratch disease and avoid abdominal excisional biopsy

Valeria Filipponi
Primo
Conceptualization
;
Francesca Maccioni
Investigation
;
Maddalena Zippi
Resources
;
Ludovica Busato
Investigation
;
Francesca Arienzo
Investigation
;
Mario Biglietto
Methodology
;
Paolina Saullo
Resources
;
Carla Giordano
Penultimo
Investigation
;
Roberto Caronna
Ultimo
Writing – Review & Editing
2022

Abstract

Abstract: The finding of lymphadenopathy is usually the consequence of a benign infection, although a neoplastic origin must always be excluded. Through a careful anamnesis, physical examination,and serological tests several differential diagnoses are frequently possible. Nevertheless, sometimes an excisional biopsy of superficial lymph nodes is required, which is the best means to reach a definitive diagnosis. More concerns arise when lymphadenopathy is only abdominal/retroperitoneal: percutaneous biopsy is often inconclusive and the excisional node biopsy becomes a surgical procedure, certainly indicated in case of malignancy but avoidable in case of inflammatory diseases. We present the case of a 30-year-old man with a deep iliac lymphadenopathy who was evaluated at the Hematological Unit of Sapienza University of Rome. The enlargement of an iliac lymph node is quite unusual for an infectious disease. Although symptoms such as pain, fever, and chills suggested it was the case, cat-scratch disease was not hypothesized. Radiological investigations did not exclude a malignant disease and a laparoscopic excisional biopsy was scheduled, but the slight improvement of his spontaneous symptoms suggested a careful follow-up. Given the lack of disappearance of lymphadenopathy, the lack of diagnosis, and an ipsilateral superficial (inguinal) lymph node with similar ultrasonographic and radiological features, the patient underwent biopsy, which disclosed a diagnosis of cat-scratch disease, avoiding more invasive surgical procedures.
2022
cat-scratch disease; abdominal lymphadenopathy; inflammatory disease; excisional biopsy
01 Pubblicazione su rivista::01i Case report
Abdominal lymphadenopathy: hypothesize cat-scratch disease and avoid abdominal excisional biopsy / Filipponi, Valeria; Trasarti, Stefania; Maccioni, Francesca; Zippi, Maddalena; Busato, Ludovica; Arienzo, Francesca; Biglietto, Mario; Saullo, Paolina; Giordano, Carla; Caronna, Roberto. - In: HEMATO. - ISSN 2673-6357. - 3:4(2022), pp. 771-778. [10.3390/hemato3040052]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1670048
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