Bartonella henselae vertebral osteomyelitis in a pediatric patient: A case report

Abstract

Bartonella henselae is an unusual and rarely suspected osteomyelitis etiologic agent. We present a case of low back-pain in a 10-year-old female which lead to a challenging diagnostic work-up due to subtle imaging findings. The diagnosis was Bartonella henselae vertebral osteomyelitis mimicking bone tumor.

Cat-scratch disease: a rare cause of osteomyelitis

“…Regarding radiological exams in osteomyelitis, MRI seems to be the best choice16 because it can identify the infection site,11 and characterise bone and surrounding tissue lesions; nevertheless, the differential diagnosis between neoplastic and infectious disease is not always possible based solely on MRI 13. In these cases, typical granulomatous inflammation on histopathological analysis of biopsy specimens16 may help in the distinction, as seen in our case.…”

“…Atypical forms of CSD are due to haematogenous, lymphatic or contiguous spread of B. henselae , which may target any organ in the human body; these are infrequent, and osteomyelitis is one of the rarest, occurring predominantly in children and independently of their immunological status 7 8 12. Opposite to haematogenous pyogenic osteomyelitis, which is usually acute and affects the appendicular skeleton, B. henselae osteomyelitis typically impacts the axial skeleton, subacutely in a single spot 8 11 13. Bone lesions are more frequently seen in the spine, particularly the lumbar spine, although other locations may also be affected 8 13.…”

“…Opposite to haematogenous pyogenic osteomyelitis, which is usually acute and affects the appendicular skeleton, B. henselae osteomyelitis typically impacts the axial skeleton, subacutely in a single spot 8 11 13. Bone lesions are more frequently seen in the spine, particularly the lumbar spine, although other locations may also be affected 8 13. Lymphadenopathy typically associates with these lesions but, not only weeks may pass between the appearance of the two, they may appear distant from each other, which delays or even precludes the diagnosis 4 14.…”

“…Presently, however, newer and better tests have improved the identification of B. henselae ,4 namely serology and PCR testing 16. The former is the gold standard for diagnosis1 15 while the later supports and strengthens the diagnosis by identifying the bacteria in the affected site or concomitant lymphadenopathy 1 13. Nevertheless, there are reports of cross-reactivity between antibodies of different Bartonella species, so that molecular methods are more specific in the distinction between them 6.…”