A 9-year-old, otherwise healthy girl has complained of pain in the right armpit for the past week. Examination shows tender, enlarged lymph nodes in the right axillary region. There are four linear and nearly healed abrasions over a 3x2 cm area of the distal ventral aspect of the right forearm and a single, 0.5-cm, slightly raised erythematous nodule over one of the abrasions. No other abnormalities are noted. Histologic examination of one of the lymph nodes shows stellate, necrotizing granulomas. The lymphadenopathy regresses over the next 2 months. Infection with which of the following is most likely to have produced these findings?
Cat-scratch disease is a form of self-limited infectious lymphadenitis that most often is seen in children, typically "downstream" of lymphatic drainage from the site of an injury on a distal extremity. Hence axillary and cervical lymph node regions are most often involved. Cytomegalovirus infection is typically seen in immunocompromised individuals and is not a common cause of lymphadenopathy. Epstein-Barr virus (EBV) infection at this age is most often associated with infectious mononucleosis and pharyngitis, and the lymphadenopathy is nonspecific. Staphylococcus aureus can produce suppurative inflammation with sepsis. Yersinia pestis, the agent that causes bubonic plague, produces lymphadenopathy that can ulcerate and a hemorrhagic necrotizing lymphadenitis; it has a high mortality rate.
Bartonella henselae
Cytomegalovirus
Epstein-Barr virus
Staphylococcus aureus
Blood