Thoracic osteomyelitis and epidural abscess formation due to cat scratch disease: case report.
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.
Departments of 1 Neurological Surgery and.
David
D
Dornbos
Family Medicine, The Ohio State University Wexner Medical Center.
Jocelyn
J
Morin
Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University; and.
Joshua R
JR
Watson
Departments of 1 Neurological Surgery and.|Division of Pediatric Neurological Surgery, Nationwide Children's Hospital, Columbus, Ohio.
Jonathan
J
Pindrik
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002372:Cat-Scratch Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002415:Cats; D002675:Child, Preschool; D020802:Epidural Abscess / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D010019:Osteomyelitis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging*
D000900:Anti-Bacterial Agents
Bartonella henselae; CRP = C-reactive protein; ESR = erythrocyte sedimentation rate; PCR = polymerase chain reaction; cat scratch disease; epidural abscess; infection; osteomyelitis