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Thoracic osteomyelitis and epidural abscess formation due to cat scratch disease: case report
David Dornbos1, Jocelyn Morin2, Joshua R Watson3
1Departments of1Neurological Surgery and.
Insights
Pediatric spinal epidural abscess and osteomyelitis are rare but serious. This case highlights Cat Scratch Disease (Bartonella henselae) as a potential cause, emphasizing prompt diagnosis for children.
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.
Abstract:
Osteomyelitis of the spine with associated spinal epidural abscess represents an uncommon entity in the pediatric population, requiring prompt evaluation and diagnosis to prevent neurological compromise. Cat scratch disease, caused by the pathogen Bartonella henselae, encompasses a wide spectrum of clinical presentations; however, an association with osteomyelitis and epidural abscess has been reported in only 4 other instances in the literature. The authors report a rare case of multifocal thoracic osteomyelitis with an epidural abscess in a patient with a biopsy-proven pathogen of cat scratch disease. A 5-year-old girl, who initially presented with vague constitutional symptoms, was diagnosed with cat scratch disease following biopsy of an inguinal lymph node. Despite appropriate antibiotics, she presented several weeks later with recurrent symptoms and back pain. Magnetic resonance imaging revealed 2 foci of osteomyelitis at T-8 and T-11 with an associated anterior epidural abscess from T-9 to T-12. Percutaneous image-guided vertebral biopsy revealed B. henselae by polymerase chain reaction analysis, and she was treated conservatively with doxycycline and rifampin with favorable clinical outcome.
