Granulomatous osteolytic lesion of the skull associated with cat-scratch disease

Muszynski, Michael J.; Eppes, Stephen C.; Riley, Harris D.

doi:10.1097/00006454-198702000-00011

Cited by 38 publications

(14 citation statements)

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“…Debido a que estas lesiones se asocian también a cierto grado de actividad osteoblástica, predominantemente periférica a la zona lítica y pesquisable a veces con la radiografía en forma de esclerosis 35,46 , el CO es capaz de detectar de manera altamente sensible y precoz un proceso osteomielítico causado por B. henselae. Además del aumento de actividad osteoblástica, la mayor captación del MDP-Tc 99m por las lesiones visible en el CO puede estar relacionada con el importante componente inflamatorio y la necrosis central presente en la biopsia 22,42,46 . Esto, unido a la capacidad de este examen de explorar todo el esqueleto de una vez, hace que el CO sea irreemplazable en el estudio de complicaciones sistémicas óseas de estos pacientes.…”

Section: Discussionunclassified

Forma atípica de enfermedad por arañazo de gato: Compromiso óseo en dos pacientes pediátricos detectado mediante cintigrafía ósea. Revisión de la literatura

et al. 2003

Rev. chil. infectol.

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Cat-Scratch Disease (CSD) is a benign, self-limited illness that occurs after scratch or bite of a cat carrier of Bartonella henselae. It presents as lymphadenopathy near to the inoculation site, and affects in 80% of cases individual younger that 21 years old. Fewer than 25% of patients will have the atypical form of the disease, with involvement of organs as liver, spleen, central nervous system and retina. Osteomyelitis has been claimed in old series as rare, although more recent publications suggest a higher incidence. Axial skeleton is the most frequently involved, especially pelvis and dorsal and lumbar spine. Skeletal lesions can be only one or multiple. Lesions not always cause pain and they can appear weeks or months after the beginning of symptoms. We describe two girls with skeletal involvement, positive serology for B. henselae and complete recovery. One of them (12 yr) had fever and abdominal pain, with a hypodense lesion in liver and multifocal osteomyelitis in spine and pelvis. The other one (10 yr) had sub-maxillary adenopathy and one painless lesion in iliac crest, which was evident in bone scan (BS), without fever or worsening of general condition. We recommend the regular use of BS in patients with CSD due to poor sensitivity of radiography in detection of bone envolvement and because these lesions can be multifocal and painless in some cases.Key words: Cat-Scratch Disease; Bartonella henselae; Osseous involvement; Osteomyelitis; Bone scan. IntroducciónEl compromiso del aparato locomotor siempre significa un reto para el médico. Sus causas son diversas: desde traumáticas, infecciosas e inflamatorias, a tumorales. Sus manifestaciones clí-nicas son variables, dependiendo de la edad del paciente y su etiología. Con este espectro tan diverso, frente a un niño con síntomas y signos músculo-esqueléticos, nuestro objetivo será siempre descartar un proceso infeccioso o tumoral. Así la patología del aparato locomotor de un recién nacido o un lactante, obligará a descartar como primera posibilidad una osteo-artritis sépti-ca, la cual habitualmente se desarrollará en el contexto de un cuadro infeccioso sistémico 1 . Es diferente en el pre-escolar y escolar, donde surge una gran gama de patologías; los cuadros infecciosos en este grupo etario ya no ocupan el primer lugar y las manifestaciones pueden estar dadas tanto por focalización del microorganismo en el esqueleto, así como ser una respuesta reactiva a la presencia del mismo en el organismo. En ellos, el cuadro clínico puede expresarse como un síndrome febril, con o sin síntomas dolorosos del aparato locomotor. Actualmente, a

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Section: Discussionunclassified

Forma atípica de enfermedad por arañazo de gato: Compromiso óseo en dos pacientes pediátricos detectado mediante cintigrafía ósea. Revisión de la literatura

et al. 2003

Rev. chil. infectol.

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“…Bone biopsy will show granulomatous inflammation with central necrosis. 12 Imaging studies such as computed tomography, magnetic resonance imaging, or bone scans are helpful to identify the lesion but are not specific. 13 Historically, diagnosis was based on meeting 3 of 4 criteria: history of an intimate exposure to a healthy cat (especially a kitten) and an inoculation site, regional adenopathy with sterile pus, a positive cat-scratch test result, and a lymph node biopsy showing granulomas and abcessess.…”

Section: Denouement and Discussionmentioning

confidence: 99%

Radiological Case of the Month

Kurbasic¹,

Vf²,

Cm³

1999

Arch Pediatr Adolesc Med

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“…Bone involvement, in the form of clinical osteomyelitis with lytic lesions on x-ray and B henselae identified by culture or pathology of the lesions, can present with systemic disease (47)(48)(49). Bone lesions may be adjacent to overlying adenopathy.…”

Section: Clinical Presentation With Csdmentioning

confidence: 99%

Cat Scratch Disease: The Story Continues

Opavsky

1997

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Evidence accumulated to date supports B henselae as the etiological agent of CSD. The most significant risk factors for CSD are being licked on the face, scratched or bitten by a kitten and owning a kitten with fleas. Available serological tests can confirm classic CSD and identify B henselae as the cause of more atypical presentations, such as fever of unknown origin, granulomatous hepatitis, encephalitis and osteomyelitis. Symptomatic management is appropriate for isolated lymphadenopathy caused by CSD in healthy individuals; however, antibiotic therapy may be indicated for patients with more severe manifestations of the disease and immunocompromised hosts. Further study of CSD, in particular the epidemiology and therapy, is warranted. A better understanding of the pathogenesis of B henselae infection will have important implications in both immunocompetent and immunocompromised individuals.

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Granulomatous osteolytic lesion of the skull associated with cat-scratch disease

Cited by 38 publications

References 0 publications

Forma atípica de enfermedad por arañazo de gato: Compromiso óseo en dos pacientes pediátricos detectado mediante cintigrafía ósea. Revisión de la literatura

Forma atípica de enfermedad por arañazo de gato: Compromiso óseo en dos pacientes pediátricos detectado mediante cintigrafía ósea. Revisión de la literatura

Radiological Case of the Month

Cat Scratch Disease: The Story Continues

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