Bartonella henselae Infection With Concurrent Latent Syphilis in a Patient With Unexplained Generalized Lymphadenopathy

Unexplained lymphadenopathy is a common clinical presentation. It has a wide differential diagnosis including infectious, malignant, lymphoproliferative, and autoimmune causes. We describe an unusual case of generalized lymphadenopathy in the setting of initial seropositivity for syphilis but a lack of response to appropriate treatment. Bartonella henselae serology was sent, given specific exposure history, and returned as positive and, with the development of ocular symptoms consistent with ocular bartonellosis, solidified a diagnosis of cat scratch disease with concurrent latent syphilis. In many cases where the etiology is not immediately evident or there exist conflicting diagnostic testing results, clinicians should identify the relevant infectious workup based on a systematic approach to history-taking to balance the risk of missing diagnoses and overdiagnosis.