title: Vertebral osteomyelitis: an unusual presentation of Bartonella henselae infection.
abstract: OBJECTIVE
  To report cases of cat scratch disease with vertebral osteomyelitis.
  
  
  METHODS
  We describe clinical features, diagnostic, treatment, and outcome of 2 patients with vertebral osteomyelitis due to Bartonella henselae and provide a review of the relevant literature.
  
  
  RESULTS
  A 47-year-old man was investigated for fever, splenomegaly, and cervical adenopathy. A lymphoma was suspected on the clinical picture, the laboratory tests, and the computed tomographic scan. [(18)F]-fluoro-2-deoxy-d-glucose-positron emission tomography detected splenic nodules and a hypermetabolic focus of C7 vertebral body compatible with a vertebral osteomyelitis on magnetic resonance imaging. B henselae infection was confirmed by polymerase chain reaction performed on lymph node biopsy. A 34-year-old woman was investigated for fever and right upper quadrant abdominal pain. She had consulted 2 weeks before for a unique lesion of right index and an axillar adenopathy that have improved spontaneously. A technetium bone scan performed 1 week later because of a thoracic backache demonstrated an increased uptake of the T6 vertebra. Vertebral magnetic resonance imaging was compatible with a T6 osteomyelitis. B henselae infection was confirmed by serology (seroconversion). Both patients were treated with rifampin and doxycycline and recovered within 3 months.
  
  
  CONCLUSIONS
  B henselae vertebral osteomyelitis can involve immunocompetent adults. In the case of vertebral osteomyelitis with negative blood cultures, recent history of local lymphadenopathy and cat exposure must be investigated and B henselae serology must be performed. Nevertheless, even if serology is positive, vertebral biopsy is required to rule out other pathogens or malignancy. B henselae infection can be confirmed by polymerase chain reaction performed on vertebral or lymph node biopsy.
authors.affiliation: Service de Médecine Interne, Centre Hospitalier Universitaire Hôtel Dieu, Nantes, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Graveleau
authors.forename: Olivier
authors.initials: O
authors.lastname: Grossi
authors.forename: Maeva
authors.initials: M
authors.lastname: Lefebvre
authors.forename: Hervé
authors.initials: H
authors.lastname: Redon
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Caignon
authors.forename: Amandine
authors.initials: A
authors.lastname: Pallardy
authors.forename: Caroline
authors.initials: C
authors.lastname: Bodet-Milin
authors.forename: Antoine
authors.initials: A
authors.lastname: Néel
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Hamidou
mesh_terms: D000328:Adult; D018416:Bartonella henselae; D002372:Cat-Scratch Disease / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications* / Q000382:microbiology* / Q000473:pathology; D013131:Spine / Q000382:microbiology* / Q000473:pathology