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General Critical Care

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A 49-year-old male noted an enlarged lymph node in his right axilla. He had no constitutional symptoms. The node was firm and moveable and slightly tender to palpation. The rest of his exam was unremarkable except for multiple small, healing, linear scratches on both hands that he said were from a new kitten, and a 2 mm papular lesion on the dorsum of his right hand which he hadn’t noticed. A CBC and chest x-ray were normal.

Because of his anxiety about a possible malignancy, the node was resected. Pathology demonstrated granulomas with neutrophilic abscesses in granuloma centers and was read as consistent with “necrotizing granulomatous lymphadenitis.”

Two months before he noticed the axillary node, he visited East Africa where he ate local food, cut his right hand on a plant leaf, and trailed his right hand in river water while in a canoe. He is an avid gardener who raises greenhouse roses and orchids. Three weeks before he felt the node he bought a kitten for his teenage daughter.

Which one of the following is the most likely cause of his axillary node enlargement?

  • 0%Mycobacterium marinum

  • 0%Sporothrix schenckii

  • 0%Nocardia brasiliensis

  • 0%Bartonella henselae

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