Objective:

To report a case of mediastinal lymphadenitis caused by Bartonella henselae presenting with airway compression in a child, mimicking malignancy.

Approach:

• Case Presentation: A 6-year-old boy with persistent fever, mild cough, weight loss, and cervical lymphadenopathy underwent imaging and bronchoscopy, revealing significant airway compression due to necrotic mediastinal lymphadenopathy.
• Diagnostic Process: Initial antimicrobial therapy failed, leading to further investigation including biopsy, which identified necrotizing granulomatous inflammation and confirmed the diagnosis of cat-scratch disease through metagenomic sequencing.

Key Findings:

• The child exhibited severe airway compression due to necrotic mediastinal lymphadenopathy.
• Initial treatment with amoxicillin and linezolid was ineffective, leading to further investigation.
• Histopathology revealed necrotizing granulomatous inflammation, and Bartonella henselae was identified as the causative agent through metagenomic sequencing.

Interpretation:

This case highlights that Bartonella henselae infection can present as a necrotic mediastinal mass with severe airway compression, which may mimic malignancy.

Limitations:

• The case is based on a single patient, limiting generalizability.
• Potential for misdiagnosis as malignancy due to overlapping clinical features.

Conclusion:

Cat-scratch disease should be included in the differential diagnosis for pediatric mediastinal masses, particularly with relevant exposure history and inflammatory features.