[Bartonella henselae vertebral osteomyelitis: report of a case]

Abstract

Cat scratch disease (CSD) is caused by Bartonella henselae, with unknown prevalence and incidence in the Chilean paediatric population. Regional lymphadenopathy is the most common presentation, while atypical forms constitute a diagnostic challenge.

Objective: To report a case of CSD with osteomyelitis and present guidelines regarding treatment.

Clinical case: An eight year-old patient, with prolonged febrile illness, back pain and neck stiffness. Laboratory studies highlight positive IgG for Bartonella henselae. The abdominal ultrasound showed splenic micro-abscesses, and the MRI showing vertebral lesions suggestive of osteomyelitis.

Discussion: The diagnosis of atypical forms requires a high rate of suspicion, as in this case, in which the patient manifested the musculoskeletal symptoms simultaneously with the febrile syndrome, which led us to study possible complications of the disease. Current knowledge of the treatment of atypical or complicated CSD is derived from the observation of case studies, rather than randomized trials. It is suggested that antibiotic therapy is analysed individually, with the help of a specialist.

Conclusion: The importance of high clinical suspicion are emphasised and discussed, as well presenting some treatment options based on the evidence from the current literature.

Keywords: Bartonella henselae; Osteomielitis; Osteomyelitis; Prolonged fever; Síndrome febril prolongado.