Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma—A Case Report and Literature Review

Abstract

Background We performed a review of published case studies of osteomyelitis associated with cat-scratch disease to consolidate existing information on clinical presentation, diagnostic tools, therapy, and outcome, as well as presenting a case of disseminated cat-scratch disease in a 12-year-old female with skull osteomyelitis and spleen involvement. Methods A search for articles indexed in PubMed, Embase, and Google Scholar was performed with the search terms “Bartonella,” “bone,” “osteomyelitis,” “osteolytic,” and “cat-scratch disease” limited to the immunocompetent pediatric population and articles in English. Results 51 cases were identified. The average age was 7.8 years with equal sex distribution. Fever (84.3%), often with a prolonged course (64.7%), and osteoarticular pain (88.2%) were the most common clinical findings. Lymphadenopathy was present in 64.7% of patients. Vertebral body was mainly involved (51.9%). MRI (50%) and bone scintigraphy (48.1%) were favored to confirm osteomyelitis, while serology was the preferred microbiological diagnostic. Various antibiotics were prescribed in combined or sequential regimens, with median duration of therapy of 23 days. About 12.5% of patients did not receive any treatment. Most patients had excellent prognosis; in particular, all patients not receiving any therapy showed complete recovery and no recurrence of symptoms. Conclusions Bartonella henselae should be considered in differential diagnosis of localized lymphadentitis. Osteoarticular pain or limitation during cat-scratch disease in children should always be investigated for bone spreading. Owing to good prognosis, invasive procedures to obtain the bone material should be avoided. Serology is the gold standard diagnostic tool and MRI is the best radiographic technique to define bone and surrounding tissue involvement. Treatment represents a never-ending dilemma: surgical intervention or use of antibiotics is still controversial, and more studies are needed to define the best antimicrobial regimen.

Cat at home? Cat scratch disease with atypical presentations and aggressive radiological findings mimicking sarcoma, a potential diagnostic pitfall

“…An atypical manifestation of CSD, such as knee soft tissue mass and osteomyelitis, as in our cohort, is rare and mainly affects children (Carithers 1985, Robson et al 1999, Donà et al 2018). Osteomyelitis associated with B. henselae frequently occurs along with regional lymphadenopathy due to hematogenous or lymphatic spread after the inoculation of the microorganisms (Florin et al 2008, Erdem et al 2018.…”

Bartonella osteomyelitis versus vertebral sarcoidosis: A tale of two cases

“…In patients with suspected CSD, any recent history of local lymphadenopathy and cat exposure must be closely scrutinised, along with serological and PCR testing for B. henselae . 4…”

“…3 In case of a negative PCR result, a diagnosis of Bartonella osteomyelitis can be established by positive serology and characteristic lymph node histopathology in an appropriate clinical scenario of regional lymphadenopathy and cat contact. 4…”

“…2 , 3 Bartonella vertebral osteomyelitis is rare, with non-specific clinical and imaging presentations. 4 Sarcoidosis is a multi-system disorder of unknown aetiology with varying presentations. The skeletal involvement in sarcoidosis is uncommon (1–13%), with rare vertebral involvement.…”

Bartonella henselae Persistence within Mesenchymal Stromal Cells Enhances Endothelial Cell Activation and Infectibility That Amplifies the Angiogenic Process

“…As B. henselae can infect CD34 + BM progenitor cells, BM has been proposed as one of the potential niches. In this regard, multifocal BM involvement was shown in CSD(54,55) and a contribution of B. henselae to ineffective erythropoiesis was suggested(56). Bartonella-infected MSCs, releasing soluble molecules, can recruit and activate ECs which in turn collaborate with MSCs in the fine regulation of the hematopoietic stem cell niche.In conclusion, this study provides novel insights into the role of MSCs in serving as a reservoir during B. henselae infection and identifies TLR2, NOD1 and EGFR as the receptors involved in the recognition of B. henselae.…”