[Cat-scratch disease with bone compromise: atypical manifestation]

Area of Science:

• Pediatric Infectious Diseases
• Bacteriology
• Medical Imaging

Background:

• Cat-scratch disease (CSD), caused by Bartonella henselae, commonly presents with fever, headache, myalgias, and lymphadenopathy.
• Less common manifestations occur in 2-10% of cases, necessitating broader diagnostic considerations.

Observation:

• Two pediatric patients presented with unusual CSD manifestations: hepatosplenic abscesses and significant bone involvement.
• One child exhibited multifocal bone scintigram abnormalities and positive CSD serology (IgG > 1/256).
• The second child presented with L2 vertebral body destruction, visualized via MRI, indicating severe skeletal compromise.

Findings:

• Bacilli consistent with Bartonella henselae were identified in bone biopsy samples from both patients using the Warthing-Starry stain.
• These findings confirm Bartonella henselae as the causative agent in these complex CSD presentations.
• The cases underscore the diagnostic utility of bone biopsy in suspected CSD with skeletal involvement.

Implications:

• This report expands the spectrum of CSD clinical presentations, emphasizing the importance of considering bone and visceral involvement.
• Early recognition and diagnosis of these rare CSD manifestations are crucial for appropriate management and to prevent long-term sequelae.
• Further research into the pathogenesis and treatment of severe CSD presentations is warranted.