Thoracic osteomyelitis and epidural abscess formation due to cat scratch disease: case report

Area of Science:

• Infectious Diseases
• Pediatric Neurology
• Spinal Surgery

Background:

• Spinal epidural abscess and osteomyelitis are uncommon in children and can lead to severe neurological deficits.
• Cat Scratch Disease (CSD), caused by Bartonella henselae, typically presents with lymphadenopathy but can have diverse manifestations.
• Literature reports few cases linking CSD to spinal infections, making this association particularly rare.

Observation:

• A 5-year-old girl with CSD developed recurrent symptoms including back pain.
• MRI revealed multifocal thoracic osteomyelitis (T-8, T-11) with a significant anterior epidural abscess (T-9 to T-12).
• Biopsy confirmed Bartonella henselae via PCR in the vertebral lesions.

Findings:

• This case presents a rare instance of multifocal thoracic osteomyelitis and spinal epidural abscess in a pediatric patient with biopsy-proven Cat Scratch Disease.
• The patient was successfully treated conservatively with doxycycline and rifampin, indicating a favorable clinical outcome.
• Polymerase chain reaction analysis was crucial for identifying Bartonella henselae in the vertebral biopsy.

Implications:

• Clinicians should consider Cat Scratch Disease in the differential diagnosis of pediatric spinal infections, especially with a history of exposure.
• Early recognition and diagnosis of pediatric spinal epidural abscess and osteomyelitis are critical to prevent neurological compromise.
• Conservative management with appropriate antibiotics may be effective for CSD-associated spinal infections.