A pediatric case of Bartonella henselae and Epstein Barr virus disease with bone and hepatosplenic involvement

Abstract

Background: Cat scratch disease (CSD) is an infectious disorder caused by Bartonella henselae. The infection usually presents as local lymphadenopathy, fever, and mild constitutional symptoms. Systemic or severe disease is reported in 5-20% of patients with CSD. We report a case of disseminated CSD with osteomyelitis and hepatosplenic disease and a review of the literature. Case report: A previously healthy 5-year-old male presented with prolonged fever and abdominal pain, followed by low back pain. The serologic test showed positive IgG for B. henselae and IgM and IgG for Epstein Barr virus (EBV). The abdominal ultrasound showed hepatic and splenic hypoechoic lesions, and the magnetic resonance imaging (MRI) revealed spondylitis of the D6 vertebra. He received treatment with azithromycin for 4 weeks and rifampicin for 6 weeks. The symptoms disappeared, and the abdominal ultrasound was normal nine months later. Conclusions: Disseminated CSD is infrequent. The diagnosis requires a high rate of suspicion. Laboratory findings of Bartonella infection are often non-specific. Serologic test, polymerase chain reaction of B. henselae in blood or biopsied material of the site of involvement and imaging test can be performed to confirm the diagnosis. The diagnosis of disseminated B. henselae was based on significantly elevated blood titers, radiologic findings, and epidemiologic history. Treatment of CSD depends on the disease presentation. Azithromycin is used as a first-line agent for lymphadenopathy. The optimum treatment and its duration have not been established in atypical or complicated CSD, including patients with osteomyelitis and hepatosplenic disease.

Atypical Cat Scratch Disease With Splenic Lesion Mimicking Kawasaki Disease in a Healthy 5-Year-old Girl

“…13,14 Several cases of atypical CSD that mimic other diseases have been reported in the literature. Other etiologies include metastatic tumors, 15 Epstein–Barr virus infection, 16 and autoimmune diseases. 17 Kara et al reported a suspected case of CSD neuroretinitis, which was eventually diagnosed as systemic lupus erythematosus based on a positive result for antinuclear antibody.…”

“…6,9 In contrast, in hepatosplenic CSD, micro-abscesses are detected in the liver and spleen, as evidenced by imaging techniques, such as ultrasound, computed tomography and magnetic resonance imaging. 16,18 Multiple granulomatous lesions are relatively specific signs, and thus, it would be reasonable to initiate treatment for atypical CSD based these characteristic imaging findings together with a history of contact with cats. 19 It should be noted, however, that these imaging findings may also closely resemble sarcoidosis, candidiasis, and advanced metastatic disease.…”

Bartonella henselae Infection May Occasionally Distract Immune Control of Latent Human Herpesviruses

“…It is important to point out that a case of concomitant B henselae and Epstein-Barr virus infection has been described. 8 Even in that case, the B henselae infection may have reactivated Epstein-Barr virus as well as HHV-6 and HHV-7 in the case described by Swink et al 1 Epstein-Barr virus reactivation has been detected in one case 8 serologic testing-IgM, IgG, Epstein-Barr virus nuclear antigen IgG, and heterophile antibodies-as there were no dermatologic manifestations that may be related to Epstein-Barr virus reactivation from latency. 9 In conclusion, a viral or bacterial infection such as Epstein-Barr virus or B henselae may have a transactivating function allowing another (latent) virus such as HHV-6 or HHV-7 to reactivate.…”

Vertebral osteomyelitis with Campylobacter jejuni – a case report and review of the literature of a very rare disease

“…in staphylococci; Kim et al, 2014) with the exception of atypical mycobacteria, where macrolides are often the backbone therapy in combination with other active substances (Griffith et al, 2007). Azithromycin has successfully been used as a stepdown oral therapy or in combination with other antibiotics in treatment of osteomyelitis with rare or resistant pathogens like Salmonella typhi (Ayeni and Calver, 2012), Bartonella henselae (Aparicio-Casares et al, 2021), or resistant pneumococci (Riordan et al, 2008), and it may be an option for treatment in combination with rifampicin (Shirtliff et al, 1999;O'Reilly et al, 1992). Although good quality evidence Abbreviations: MIC: minimal inhibitory concentration, qd: once a day, bid: twice a day, tid: three times a day, iv: intravenous, po: per os is still lacking, azithromycin may be a treatment option in select cases.…”