A Tough Diagnosis in a Neutropenic Patient: It's Cat-Scratch Disease

To the Editor.—  I applaud the efforts of English et al¹ in their investigation of the etiology of cat-scratch disease. While it would appear to be a relatively benign disease, cat-scratch disease posed significant diagnostic dilemmas in the case of a 54-year-old woman.

Report of a Case.—  The patient presented with a three-year history of refractory anemia and myelodysplastic syndrome with frequent periods of absolute neutropenia. She lived on a farm and frequently suffered minor trauma from her cats and from her activities on the farm.She was admitted to the National Institutes of Health after 11 days of a severe left-sided headache. On examination, she had no fever but did have marked tenderness in the left parietal area, neck, and temporomandibular area and bilateral cervical lymphadenopathy. Her absolute neutrophil count was 972 and the sedimentation rate was 119 mm/h. A head computed tomogram showed swelling of the left