{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:15:23Z","timestamp":1760055323821,"version":"build-2065373602"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Cat scratch disease (CSD), caused by <jats:italic>Bartonella henselae (B. henselae)<\/jats:italic>, typically presents as localized swelling of lymph nodes following a scratch or bite from a cat. It is crucial to differentiate CSD from tuberculosis (TB), particularly in regions where TB is prevalent. This report describes a 56-year-old man who exhibited bilateral swelling of the cervical lymph nodes. Initially, he was suspected to have tuberculous lymphadenitis due to the granulomatous changes observed in a biopsy of the lymph nodes, typical signs of TB on a chest CT scan, and a positive result from an interferon-gamma release assay (IGRA). He was subsequently referred to our hospital for TB treatment. Testing of bronchoalveolar lavage fluid confirmed the presence of TB-DNA, indicating active pulmonary tuberculosis (PTB). However, further investigation revealed recent cat contact. This led to the identification of a <jats:italic>B. henselae<\/jats:italic> infection using metagenomic pathogen detection workflow (MetaPath\u2122) on formalin-fixed paraffin-embedded (FFPE) histopathological sections from a cervical lymph node specimen obtained at an external hospital, which confirmed the diagnosis of CSD and ruled out TB. Through a review of the literature, we found that this represents the first documented case of concurrent active PTB and CSD-related lymphadenitis in an immunocompetent individual. It highlights the diagnostic challenges in distinguishing CSD from TB in cases of granulomatous lymphadenitis and emphasizes the need to consider CSD in patients with a history of cat exposure, showcasing the pivotal role of advanced metagenomic diagnostics in accurately diagnosing CSD.<\/jats:p>","DOI":"10.3389\/fmed.2025.1667171","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T04:21:43Z","timestamp":1759983703000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Coexistence of cat scratch disease lymphadenitis and active pulmonary tuberculosis in an immunocompetent host \u2013 a case report with metagenomic diagnosis and literature review"],"prefix":"10.3389","volume":"12","author":[{"given":"Xuan","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shufang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chengqing","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s12348-023-00334-5","article-title":"Central retinal vein occlusion associated with bartonella henselae infection.","volume":"13","author":"Bellur","year":"2023","journal-title":"J Ophthalmic Inflamm Infect."},{"key":"B2","doi-asserted-by":"publisher","first-page":"21","DOI":"10.5177\/ntvt.2021.01.20049","article-title":"Cat scratch disease.","volume":"128","author":"Kamstra","year":"2021","journal-title":"Ned Tijdschr Tandheelkd."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e1413","DOI":"10.1542\/peds.2007-1897","article-title":"Beyond cat scratch disease: widening spectrum of bartonella henselae infection.","volume":"121","author":"Florin","year":"2008","journal-title":"Pediatrics."},{"key":"B4","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1046\/j.1365-2303.2002.00418.x","article-title":"Fine needle aspiration cytology of suspected tuberculous lymphadenitis.","volume":"13","author":"Bezabih","year":"2002","journal-title":"Cytopathology."},{"key":"B5","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1093\/cid\/cir454","article-title":"Current diagnosis and management of peripheral tuberculous lymphadenitis.","volume":"53","author":"Fontanilla","year":"2011","journal-title":"Clin Infect Dis."},{"key":"B6","doi-asserted-by":"publisher","first-page":"S71","DOI":"10.1309\/jc8ym53l4e0l6pt5","article-title":"Cat-scratch disease: historic, clinical, and pathologic perspectives.","volume":"121","author":"Lamps","year":"2004","journal-title":"Am J Clin Pathol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/j.ijporl.2015.12.026","article-title":"Non-tuberculous mycobacterial head and neck infections in children: analysis of results and complications for various treatment modalities.","volume":"82","author":"Mahadevan","year":"2016","journal-title":"Int J Pediatr Otorhinolaryngol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1111\/j.1525-1470.1990.tb01066.x","article-title":"Cat-scratch disease: a review of the literature.","volume":"7","author":"Shinall","year":"1990","journal-title":"Pediatr Dermatol."},{"key":"B9","first-page":"101","article-title":"Cat-scratch disease: epidemiology, aetiology and treatment.","volume":"58","author":"Windsor","year":"2001","journal-title":"Br J Biomed Sci."},{"key":"B10","doi-asserted-by":"publisher","first-page":"102732","DOI":"10.1016\/j.jiac.2025.102732","article-title":"Disseminated cat-scratch disease during abatacept therapy for rheumatoid arthritis in an older patient: a case report and review of the literature.","volume":"31","author":"Saito","year":"2025","journal-title":"J Infect Chemother."},{"key":"B11","doi-asserted-by":"publisher","first-page":"292","DOI":"10.4103\/tjo.tjo_29_20","article-title":"A child with a rare presentation of ocular bartonellosis.","volume":"11","author":"Shariffudin","year":"2021","journal-title":"Taiwan J Ophthalmol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"574","DOI":"10.5152\/TurkArchPediatr.2024.24032","article-title":"Clinical presentation of cat scratch disease in pediatric patients-a single-center study.","volume":"59","author":"\u00d6cal-Demir","year":"2024","journal-title":"Turk Arch Pediatr."},{"key":"B13","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1111\/tbj.13581","article-title":"Atypical cat-scratch disease: a radiology-pathology correlation.","volume":"26","author":"Dwan","year":"2020","journal-title":"Breast J."},{"key":"B14","first-page":"545","article-title":"[Cat scratch disease showing clinical picture resembling tuberculous lymphadenitis: a case report].","volume":"76","author":"Machi","year":"2001","journal-title":"Kekkaku."},{"key":"B15","doi-asserted-by":"publisher","first-page":"168","DOI":"10.5694\/j.1326-5377.1999.tb127714.x","article-title":"Cat scratch disease diagnosed by polymerase chain reaction in a patient with suspected tuberculous lymphadenitis.","volume":"170","author":"Gottlieb","year":"1999","journal-title":"Med J Aust."},{"key":"B16","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1055\/s-0029-1233488","article-title":"Cat scratch disease\u2013heterogeneous in clinical presentation: five unusual cases of an infection caused by bartonella henselae.","volume":"222","author":"Weinspach","year":"2010","journal-title":"Klin Padiatr."},{"key":"B17","doi-asserted-by":"publisher","first-page":"bcr2013010424","DOI":"10.1136\/bcr-2013-010424","article-title":"Cat scratch disease and lymph node tuberculosis in a colon patient with cancer.","volume":"2013","author":"Matias","year":"2013","journal-title":"BMJ Case Rep."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1969","DOI":"10.2169\/naika.100.1969","article-title":"[Case report: a case of cat scratch disease in elderly patient needed to differentiate tuberculous lymphadenitis].","volume":"100","author":"Tasato","year":"2011","journal-title":"Nihon Naika Gakkai Zasshi."},{"key":"B19","doi-asserted-by":"publisher","first-page":"906","DOI":"10.12659\/ajcr.909325","article-title":"Cat-scratch disease in an aids patient presenting with generalized lymphadenopathy: an unusual presentation with delayed diagnosis.","volume":"19","author":"Mantis","year":"2018","journal-title":"Am J Case Rep."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1558","DOI":"10.1016\/j.jiac.2022.07.013","article-title":"Clinical utility of whole body diffusion-weighted imaging in an immunocompetent adult with atypical cat scratch disease.","volume":"28","author":"Kagatani","year":"2022","journal-title":"J Infect Chemother."},{"key":"B21","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1111\/hdi.13223","article-title":"Unexplained fever in a hemodialysis patient possibly due to cat scratch disease opportunistic infection.","volume":"29","author":"Do\u011fan","year":"2025","journal-title":"Hemodial Int."},{"key":"B22","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s12348-024-00387-0","article-title":"Application of metagenomic next-generation sequencing in the diagnosis of bartonella neuroretinitis: a case report and literature review.","volume":"14","author":"Li","year":"2024","journal-title":"J Ophthalmic Inflamm Infect."},{"key":"B23","doi-asserted-by":"publisher","first-page":"397437","DOI":"10.1155\/2014\/397437","article-title":"Atypical presentation of cat-scratch disease in an immunocompetent child with serological and pathological evidence.","volume":"2014","author":"At\u0131c\u0131","year":"2014","journal-title":"Case Rep Pediatr."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e247805","DOI":"10.1136\/bcr-2021-247805","article-title":"Severe bartonella henselae bone infection in a kidney transplanted young man.","volume":"15","author":"Christensen","year":"2022","journal-title":"BMJ Case Rep."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1046666","DOI":"10.3389\/fpubh.2022.1046666","article-title":"Cat scratch disease in a 23-year-old male-case report.","volume":"10","author":"Waseem","year":"2022","journal-title":"Front Public Health."},{"key":"B26","doi-asserted-by":"publisher","first-page":"345","DOI":"10.26444\/aaem\/89547","article-title":"Cat scratch disease in a 1.5-year-old girl - case report.","volume":"25","author":"Karski","year":"2018","journal-title":"Ann Agric Environ Med."},{"key":"B27","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1053\/jinf.2002.1040","article-title":"Bartonella quintana and mycobacterium tuberculosis coinfection in an hiv-infected patient with lymphadenitis.","volume":"46","author":"Bernit","year":"2003","journal-title":"J Infect."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1584189","DOI":"10.3389\/fcimb.2025.1584189","article-title":"Clinicopathological characteristics and diagnostic performance of metagenomic pathogen detection technology in mycobacterial infections among Hiv patients.","volume":"15","author":"Li","year":"2025","journal-title":"Front Cell Infect Microbiol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1146\/annurev-pathmechdis-012418-012751","article-title":"clinical metagenomic next-generation sequencing for pathogen detection.","volume":"14","author":"Gu","year":"2019","journal-title":"Annu Rev Pathol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1038\/s41591-020-1105-z","article-title":"Rapid pathogen detection by metagenomic next-generation sequencing of infected body fluids.","volume":"27","author":"Gu","year":"2021","journal-title":"Nat Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"946849","DOI":"10.3389\/fcimb.2022.946849","article-title":"Metagenomic next-generation sequencing may assist diagnosis of cat-scratch disease.","volume":"12","author":"Li","year":"2022","journal-title":"Front Cell Infect Microbiol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1322651","DOI":"10.3389\/fcimb.2023.1322651","article-title":"Case report of diagnosis of cat-scratch disease using metagenomic next-generation sequencing.","volume":"13","author":"Zhou","year":"2023","journal-title":"Front Cell Infect Microbiol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1186\/s12886-023-03063-4","article-title":"Cat-scratch disease manifesting as uveitis and binocular fundus nodular lesions: a case report.","volume":"23","author":"Hong","year":"2023","journal-title":"BMC Ophthalmol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1186\/s12941-020-00370-2","article-title":"Hemophagocytic lymphohistiocytosis is associated with bartonella henselae infection in a patient with multiple susceptibility genes.","volume":"19","author":"Yang","year":"2020","journal-title":"Ann Clin Microbiol Antimicrob."},{"key":"B35","doi-asserted-by":"publisher","first-page":"e13829","DOI":"10.1111\/tid.13829","article-title":"Into the unknown: diagnosing mysterious brain lesions.","volume":"24","author":"Kassab","year":"2022","journal-title":"Transpl Infect Dis."},{"key":"B36","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1016\/j.ijid.2020.09.007","article-title":"The clinical value of metagenomic next-generation sequencing in the microbiological diagnosis of skin and soft tissue infections.","volume":"100","author":"Wang","year":"2020","journal-title":"Int J Infect Dis."},{"key":"B37","doi-asserted-by":"publisher","first-page":"9016","DOI":"10.1038\/s41467-024-51470-y","article-title":"Laboratory validation of a clinical metagenomic next-generation sequencing assay for respiratory virus detection and discovery.","volume":"15","author":"Tan","year":"2024","journal-title":"Nat Commun."},{"key":"B38","doi-asserted-by":"publisher","first-page":"992","DOI":"10.1097\/iae.0000000000003406","article-title":"Metagenomic next-generation sequencing detects pathogens in endophthalmitis patients.","volume":"42","author":"Zhu","year":"2022","journal-title":"Retina."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1667171\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T04:21:44Z","timestamp":1759983704000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1667171\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,9]]},"references-count":38,"alternative-id":["10.3389\/fmed.2025.1667171"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1667171","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,9]]},"article-number":"1667171"}}