Kolkata: An eight-year-old boy from south Kolkata was admitted to the ICU at Peerless Hospital with life-threatening neurological illness from a seemingly harmless scratch by a cat. All diagnostic tests failed to nail the cause of the repeated seizures for which the boy needed ventilation support.It was during history taking that doctors came to know that the child slept with a cat. This led them to diagnose it as a case of cat-scratch disease, caused by bacteria, post a bite or scratch by a cat. While uncommon, this infection is mostly mild, but could be life threatening in rare cases.Parents of the boy took him to the hospital on July 10 after he suffered a seizure at home. What initially appeared to be an isolated neurological event progressed rapidly into epilepticus, a medical emergency in which seizures continue for a prolonged period or recur without the patient regaining consciousness. The seizures remained uncontrolled despite multiple anti-seizure medications, prompting doctors to shift the boy to the Paediatric Intensive Care Unit, where he was placed under deep sedation, intubated and put on mechanical ventilation.A multidisciplinary team at Peerless Hospital began its hunt for to find the cause of the illness by launching extensive investigations for infectious and autoimmune diseases. A Brain MRI and cerebrospinal fluid examinations failed to identify an obvious infectious cause. As the seizures continued, the treating team considered the possibility of New-Onset Refractory Status Epilepticus (NORSE), a rare neurological syndrome in which previously healthy individuals suddenly develop severe, treatment-resistant seizures.In the meantime the child developed fever, prompting consultations with specialists in paediatric neurology and infectious diseases. Parents said that about ten days before the seizures, the child had developed faint pinkish rashes over his lower limbs and also had a markedly enlarged lymph node in his left armpit. This prompted doctors to suspect cat-scratch disease. An antibody testing nailed Bartonella causing the infection. Bartonella infection is caused by a group of bacteria that spread through animal scratches, bites, or bugs like fleas and lice.Shubranshu Sekhar Sarkar, consultant, paediatrician, Peerless Hospital, said, “Although cat-scratch disease is usually a benign infection, it can rarely present with life-threatening neurological complications such as refractory status epilepticus.” The boy’s condition improved and ventilator support was withdrawn after five days. He was sent home after about 10 days.
