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Cat-scratch disease. Subtle vertebral bone marrow abnormalities demonstrated by MR imaging and radionuclide bone scan
1Department of Radiology, University of North Carolina School of Medicine, Chapel Hill 27599-7510, USA.
Abstract:
Cat-scratch disease (CSD) is a benign, self-limited cause of lymphadenitis occurring mainly in children and young adults. Its etiology is a delicate, small gram-negative pleomorphic bacillus. Less common manifestations of CSD are seen in 5% of patients and include Parinaud's oculoglandular syndrome (with enlargement of the preauricular nodes), parotid gland enlargement, encephalitis, radiculopathy, pneumonitis, erythema nodosum, thrombocytopenia, and lytic bone lesions. We describe a patient in whom magnetic resonance imaging initially detected subtle vertebral bone marrow abnormalities that correlated with the site of abnormality on a subsequent radionuclide bone scan.
Insights
Cat-scratch disease (CSD) can cause bone lesions, which are rare but serious. Imaging like MRI and bone scans can detect these vertebral abnormalities in patients with CSD.
Area of Science:
- Infectious Diseases
- Radiology
- Pediatrics
Background:
- Cat-scratch disease (CSD) is a common bacterial infection, typically causing lymphadenitis.
- Caused by Bartonella henselae, CSD usually presents as a mild, self-limiting illness.
- Less common CSD manifestations affect approximately 5% of patients, including neurological and dermatological symptoms.
Observation:
- This case highlights vertebral bone marrow abnormalities as an uncommon CSD manifestation.
- Subtle vertebral bone marrow changes were initially detected using magnetic resonance imaging (MRI).
- Radionuclide bone scan confirmed the abnormalities at the same vertebral site.
Findings:
- CSD can manifest with lytic bone lesions, which may be subtle on initial imaging.
- Integrated use of MRI and radionuclide bone scanning aids in diagnosing bone involvement in CSD.
- Early detection of vertebral abnormalities is crucial for appropriate management.
Implications:
- This case expands the spectrum of CSD presentations to include vertebral bone marrow abnormalities.
- Radiologists and clinicians should consider CSD in the differential diagnosis of vertebral bone lesions, especially in endemic areas.
- Further research is needed to elucidate the pathogenesis and optimal treatment of skeletal CSD.