Cat‐Scratch Disease with Paravertebral Mass and Osteomyelitis

Robson, Jenny; Harte, Glenn J.; Osborne, David; McCormack, J. G.

doi:10.1086/515102

Cited by 62 publications

(31 citation statements)

References 18 publications

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“…B. henselae serology and PCR are very useful current tools to confirm CSD osteomyelitis. Serology was positive in most of the CSD osteomyelitis cases (13,14,18,21). Serology in our case was done by indirect immunofluorescence, and the cutoff values for positive serology were at a dilution of 1/128 for IgG and of 1/64 for IgM (7).…”

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confidence: 74%

“…Serology in our case was done by indirect immunofluorescence, and the cutoff values for positive serology were at a dilution of 1/128 for IgG and of 1/64 for IgM (7). Positive PCR has been reported in only two lymph nodes and in six osseous tissues of CSD osteomyelitis (6,10,13,14,17,18,21). In our case, we tested both the osseous and the lymph node materials.…”

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confidence: 76%

“…We think that in this case, the spreading mode was contiguous from an involved cervical lymph node adjacent to the vertebral body. Most patients recover from CSD osteomyelitis and it is not clear whether antibiotics contribute to the recovery (13,18). In our case, however, surgery had to be undertaken.…”

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confidence: 79%

“…Atypical presentations, such as ocular involvement, encephalopathy, hepatosplenic infection, endocarditis, or osteomyelitis, are seen in up to 14% of the cases (9,16). Osteomyelitis associated with CSD occurs mainly in children (13,18). So far, there have only been four reports of CSD osteomyelitis in immunocompetent adults (12,14,21,22).…”

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confidence: 99%

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Osteomyelitis Caused by Bartonella henselae Genotype I in an Immunocompetent Adult Woman

Woestyn¹,

Moreau²,

Munting

et al. 2003

J Clin Microbiol

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We report the first description of osteomyelitis due to Bartonella henselae genotype I in an immunocompetent middle-aged woman. The diagnosis was established by serology, histopathology, and PCR analysis of osseous and lymph node tissues. The mycobacteria growth indicator tube inoculated with the lymph node aspirate was used for PCR analysis. CASE REPORTA 62-year-old woman presented with a 2-week history of cervical column tumefaction. She complained of severe pain in the cervical column with radiation of the pain and paresthesia in both arms. She had intermittent fevers and night sweats. Her medical history included an epithelioma of the psoas treated by radiotherapy at age 49 and an endometrial carcinoma treated by surgery and radiotherapy at age 50. She was initially taking no medication. She lived in Belgium and owned about 20 cats.Clinical examination revealed a left cervical tumefaction. The remainder of the examination, including the neurological one, revealed no abnormalities. Hemoglobin and leukocyte levels were normal. C-reactive protein level was elevated, at 12.3 mg/liter. Tumor markers were normal. HIV serology was negative. Ultrasound of the cervical tumefaction suggested a buildup of necrotic lymphadenopathies. A computed tomography scan showed the presence of a paravertebral mass with involvement of the C5 and C6 cervical vertebrae, suggestive of metastatic infiltration. In view of her past medical history, the initial diagnosis was a recurrence of her endometrial carcinoma. A needle aspiration of the cervical tumefaction was undertaken. Histological examination showed necrotizing granulomatous inflammation indicative of cat scratch disease (CSD). Serological testing done by indirect immunofluorescence on Bartonella henselae slides commercialized by Focus Technologies (Cypress, California) was positive for immunoglobulin G (IgG), with a titer at 256. Magnetic resonance imaging (MRI) performed a few days later showed spondylitis with diskitis of the C5 and C6 vertebrae, phlegmona at the same level, and left cervical lymphadenopathies suggestive of tuberculosis. A Mantoux test was negative. Chest radiography was normal. Mycobacterial cultures from the feces and the gastric liquid were made. The patient was discharged with a suspicion of Mycobacterium tuberculosis infection. The C-reactive protein level was at 80 mg/liter, and the white blood cell count was 14.8 ϫ 10 9

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confidence: 74%

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confidence: 76%

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confidence: 79%

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confidence: 99%

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Osteomyelitis Caused by Bartonella henselae Genotype I in an Immunocompetent Adult Woman

Woestyn¹,

Moreau²,

Munting

et al. 2003

J Clin Microbiol

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“…Patients with osteomyelitis attributed to cat scratch disease have been successfully treated with erythromycin, azithromycin, rifampin, tetracycline, and gentamicin either alone or in combination (7,9,11). In a retrospective review of patients with systemic symptoms related to cat scratch disease, Margileth concluded that rifampin, ciprofloxacin, trimethoprimsulfamethoxazole, and gentamicin were all potentially effective (8).…”

Section: Fig 1 Head Ct Demonstrating the Right Lateral Orbital Massmentioning

confidence: 99%

Cat Scratch Disease Presenting as Orbital Abscess and Osteomyelitis

et al. 2003

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Ocular manifestations of cat scratch disease are uncommon. The diagnosis is usually made on the basis of increasing Bartonella henselae serum antibody titers. We report a child presenting with orbital abscess and osteomyelitis who was diagnosed with hepatosplenic cat scratch disease by detection of B. henselae DNA in the orbital abscess fluid. CASE REPORTA 3-year-old girl presented with a fever of up to 40.0°C and worsening right eyelid edema, erythema, and tenderness. Shortly after the onset of symptoms, she was evaluated by her pediatrician and diagnosed with periorbital cellulitis. She was treated with amoxicillin-clavulanate. Despite oral antibiotics, her symptoms worsened over a 3-week period and she was taken to a nearby hospital. Computed tomographic (CT) imaging of her head revealed a 2-cm mass in the extraconal space of the lateral orbit with adjacent lytic bony changes (Fig. 1). She was transported to The Children's Hospital of Philadelphia for further management. Her history was significant for multiple scratches to her face and body from a recently acquired kitten. Her past medical history was otherwise unremarkable.On arrival, her examination revealed proptosis of the right eye with significant periorbital edema, erythema, and tenderness. There was no pain with extraocular movements, but rightside gaze was limited. The right eye conjunctiva was mildly injected. The fundi were normal. There was no lymphadenopathy or hepatosplenomegaly. The remainder of her physical examination was unremarkable.Laboratory analyses revealed the following: white blood cell count, 13,100/mm 3 (68% segmented neutrophils, 21% lymphocytes, and 7% monocytes); platelets, 560,000/mm 3 ; hemoglobin, 10.8 g/dl. CT of the chest and abdomen, performed to exclude metastatic malignancy, revealed retroperitoneal lymphadenopathy and numerous hypodense liver and spleen lesions (Fig. 2). Bartonella henselae immunoglobulin M (IgM) was 1:20 (reference range, Ͻ1:20), and B. henselae IgG was 1:64 (reference range, Յ1:32). The erythrocyte sedimentation rate (ESR) was 105 mm/h, and the C-reactive protein (CRP) level was 5.43 mg/dl.The lateral orbital mass was drained of purulent fluid. There were no other collections. No organisms were seen on Gram stain. Culture of the aspirated material was negative for aerobic and anaerobic bacteria, acid-fast bacilli, and fungi. Postoperative magnetic resonance imaging of the orbit showed posterolateral irregularity of the bone consistent with orbital osteomyelitis. Preoperatively, she was treated with ampicillinsulbactam. Postoperatively, when specimens of the aspirated fluid were positive for B. henselae by PCR (Centers for Disease Control and Prevention, Atlanta, Ga.), she also received rifampin. Her fever resolved on the seventh day of hospitalization. The ESR and CRP level were 50 mm/h and 1.0 mg/dl, respectively, 3 weeks after drainage and were normal 5 weeks later. The patient completed a 5-week course of ampicillinsulbactam plus rifampin.

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BartonellaandAfipia

Sander

2010

Topley &Amp; Wilson's Microbiology and Microbial Infections

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Cat‐Scratch Disease with Paravertebral Mass and Osteomyelitis

Cited by 62 publications

References 18 publications

Osteomyelitis Caused by Bartonella henselae Genotype I in an Immunocompetent Adult Woman

Osteomyelitis Caused by Bartonella henselae Genotype I in an Immunocompetent Adult Woman

Cat Scratch Disease Presenting as Orbital Abscess and Osteomyelitis

BartonellaandAfipia

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