Unilateral Submandibular Lymphadenopathy in a 7-Year-Old Boy

Background. A 7-year-old boy presented with a 3-week history of an ulcerated vesicle on his left cheek, left-sided facial swelling, and left submandibular lymphadenopathy after being scratched by a kitten. The swelling wors-ened despite a course of cephalexin for an assumed case of lymphangitis. Given his history of contact with a cat and clinical presentation, he was given a presumptive diagnosis of cat-scratch disease. He was prescribed a 5-day course of azithromycin and had full resolution of his symptoms approximately 2 weeks later. Cat-scratch disease, a bacterial infection caused by Bartonella henselae , is a common pediatric condition characterized by local lymphadenopathy and fever after being scratched by a cat. It can be diagnosed clinically based on history and physical exam findings and is usually a benign and self-limited condition in immunocompetent pediatric patients. afebrile, alert, active, and in no acute distress. Examination of the skin revealed a 1-cm raised, firm, nontender, erythematous circular nodule adjacent to the nose on the left cheek with an overlying 3-4 mm vesicle. The vesicle was open, circular, and appeared to be healing well without exudate. The submandibular area was swollen, painless to palpation, nonerythematous and nonfluctuant. The patient had mildly boggy nasal turbinates with no Physical examination was otherwise unremarkable.