An Atypical Case of Bartonella henselae Osteomyelitis and Hepatic Disease

Abstract

Bartonella henselae is a Gram-negative bacterium and the causative agent of cat scratch disease (CSD). Atypical presentations of B. henselae that involve the musculoskeletal, hepatosplenic, cardiac, or neurologic systems are rare. In this case report, we describe a case of B. henselae osteomyelitis involving bilateral iliac bones complicated by hepatic lesions in a 12-year-old immunocompetent female patient. Although B. henselae is a rare cause of osteomyelitis, it should be considered when patients who present with fever, pain, and lymphadenopathy do not respond to routine osteomyelitis therapy.

Costal osteomyelitis due to <i>Bartonella</i> <i>henselae</i> in a 10-year-old girl

“…Standard radiology was performed for 17 children, focusing on the painful segment. Osteolysis was sometimes found and in some cases associated with sclerosis or even a periosteal reaction within an infiltration of the surrounding soft tissues (Carithers, 1983;Johnson et al, 1985;Mazur-Melewska et al, 2015;Rohr et al, 2012). CT scans (performed on 25 children) confirmed bone destruction.…”

Hepatosplenic abscesses in an immunocompetent child with cat-scratch disease from Peru

“…Atypical clinical manifestations of CSD would make the diagnosis a difficult task in certain cases, as this is not mostly considered in the differential etiologies. However, history of contact with cats and persistent fever, with serological tests availability help in the clinical and etiological diagnosis [3, 16, 19–21], but given the previous reported cases, evidence of hepatosplenic micro-abscesses would be associated with CSD. Some cases would also develop granulomatous hepatitis with increase in the hepatic transaminases [22].…”

“…After inoculation, the bacteria colonize endothelial cells, and then they are released into the bloodstream, where they infect the erythrocytes helped through their virulence factors, such as deformin and motilin that allow the membrane penetration of the red blood cells. Antiapoptotic substances that inhibit the erythrocytic phagosome are also involved, allowing the bacteria to divide and multiply until reaching the critical density that led to clinical disease [3].…”

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

“…The typical reservoir is the cat (particularly young kittens) 1,5 . B. henselae infections are thought to occur when humans are bitten or scratched by an infected cat 1,2,4,6,7 . It may also be transmitted by cat fleas or ticks 4,[6][7][8] or by an infected cat licking the non-intact skin of a person 1,4,6,7 .…”

“…B. henselae infections are thought to occur when humans are bitten or scratched by an infected cat 1,2,4,6,7 . It may also be transmitted by cat fleas or ticks 4,[6][7][8] or by an infected cat licking the non-intact skin of a person 1,4,6,7 . Cat fleas (Ctenocephalides felis) are responsible for horizontal transmission of the disease from cat to cat 1,8 .…”