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An otherwise healthy, 7 1/2-year-old girl had a two-week history of a swelling behind her left ear. She had no systemic illness and noted no improvement with a course of amoxicillin–clavulanate. Examination revealed a red, tender, retroauricular fluctuant lymph node measuring 2 by 2 cm behind her left earlobe. No other lymph nodes were enlarged. The child reported having regular contact with cats and remembered being scratched by one two weeks earlier, shortly before the mass appeared. Bartonella henselae infection was confirmed by serologic analysis. She underwent lymph-node drainage and a course of azithromycin, with clinical improvement.
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