Cat-scratch disease associated with erythema nodosum.

Before 1983 physicians diagnosed cat-scratch disease by its clinical manifestations and a positive Hanger-Rose skin test. Three out of four criteria, as outlined by Warwick, 1 were required for diagnosis. In 1983 Wear, et al.2 reported that they found gram-negative pleomorphic organisms using the Warthin-Starry stain on lymph nodes from patients with cat-scratch disease. The organism was then isolated by culture in 1986.3 Occasionally, cat-scratch disease can cause atypical manifestations that make the diagnosis difficult. Furthermore, the Hanger-Rose skin test has a 5 percent false-positive and a 5 percent false-negative rate. l Atypical manifestations include encephalitis, osteomyelitis, the Parinaud oculoglandular syndrome, and various nonspecific skin manifestations. l With the new diagnostic techniques, the disease is being redefined. We report a patient who had erythema nodosum as a presenting manifestation of cat-scratch disease. Our case is the first example of this association proved by Warthin-Starry stain and by culture.