Bartonella Osteomyelitis of the Acetabulum: Case Report and Review of the Literature.
BACKGROUND
Bartonella henselae commonly involves the mononuclear phagocyte system (MPS), and its most common presentation is lymphadenitis. Rarely, it can cause isolated osteomyelitis. We present a case of a 3 year old with constitutional symptoms and new onset of limp. Previously reported cases of osteomyelitis due to B. henselae are also reviewed here, keeping the index case in mind.


METHODS
We conducted a Medline search using MeSH subject headings Bartonella and osteomyelitis, limited to humans.


RESULTS
The index case is a 3-year-old female who had a subacute presentation with new-onset leg pain and fever. Subsequent imaging demonstrated osteomyelitis of the acetabulum. Multiple diagnostic attempts were unsuccessful, and the patient did not respond to empiric therapy. Despite indeterminate serology, the diagnosis of Bartonella osteomyelitis was eventually confirmed by PCR on bone biopsy of the lesion. The literature search revealed 48 publications, which were reduced to 28 when limiting articles to the English language and the pediatric population. After a report of 36 pediatric cases in 2007, there have been an additional 12 pediatric cases since 1998. Generally, these patients had a subacute presentation with relatively mild constitutional symptoms. Most commonly, bone involvement occurred as osteolytic lesions of the axial skeleton. Of the total 48 cases reported, only four reported involvement of the axial skeleton.


CONCLUSIONS
We present the first case, to our knowledge, of pediatric osteomyelitis of the pelvis due to B. henselae with indeterminate serologic and positive PCR results. Bartonella osteomyelitis should be included in the differential diagnosis when typical pathogens are not identified or if the patient is slow to respond to standard therapies. The sensitivity of tissue PCR for Bartonella osteomyelitis is now better than the current gold standard of serology, and new management guidelines may need to reflect this.
1 Pediatrics Resident, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
Kriti
K
Puri
2 Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
Andrew J
AJ
Kreppel
2 Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio.
Elizabeth P
EP
Schlaudecker
D000077:Acetabulum / Q000473:pathology*; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use; D018416:Bartonella henselae / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D001706:Biopsy; D002675:Child, Preschool; D005260:Female; D005334:Fever; D006801:Humans; D008199:Lymphadenitis; D010019:Osteomyelitis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016133:Polymerase Chain Reaction; D012293:Rifampin / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D017963:Azithromycin; D012293:Rifampin
Bartonella henselae; PCR; Pediatric osteomyelitis