An 8-year-old female, with no significant past medical history (PMH), presented to the Emergency Department (ED) for evaluation of 1-month painful left inguinal lymphadenopathy. A 6-month-old kitten had scratched her legs prior to symptom onset. She had experienced fever and night sweats over 2-3 weeks. Blood tests, collected 2-3 weeks into illness, were significant for Brucella immunoglobulin M (IgM) positive, Brucella immunoglobulin G (IgG) negative, Bartonella serologies negative, Epstein-Barr virus (EBV) and Cytomegalovirus (CMV) serologies negative, and tuberculosis (TB) quantiferon gold negative. At ED presentation, she had already completed 5 days of cephalexin, 10 days of clindamycin, and 5 days of azithromycin.
Fever recurred at time of ED presentation. Physical exam was significant for bilateral inguinal and right submandibular lymphadenopathy. COVID-19 test was positive. Notably, total Brucella antibody was negative. Bartonella henselae IgG and IgM were positive (IgG >1:1024, IgM 1:256). Fever and elevated inflammatory markers were attributed to COVID-19 infection. Supportive care was continued without further therapy, as patient had already completed 5 days of azithromycin. At 1 week follow-up, lymphadenopathy persisted with mild tenderness.