Thoracic osteomyelitis and epidural abscess formation due to cat scratch disease: case report

• Published in: Journal of neurosurgery. Pediatrics Vol. 25; no. 6; pp. 713 - 716
• Main Authors: Dornbos, 3rd, David, Morin, Jocelyn, Watson, Joshua R, Pindrik, Jonathan
• Format: Journal Article
• Language: English
• Published: United States 01-12-2016
• Subjects: Animals; Anti-Bacterial Agents - therapeutic use; Cat-Scratch Disease - complications; Cat-Scratch Disease - diagnostic imaging; Cat-Scratch Disease - drug therapy; Cats; Child, Preschool; Epidural Abscess - diagnostic imaging; Epidural Abscess - drug therapy; Epidural Abscess - etiology; Female; Humans; Osteomyelitis - diagnostic imaging; Osteomyelitis - drug therapy; Osteomyelitis - etiology; Thoracic Vertebrae - diagnostic imaging; osteomyelitis; ESR = erythrocyte sedimentation rate; infection; Bartonella henselae; cat scratch disease; CRP = C-reactive protein; epidural abscess; PCR = polymerase chain reaction
• ISSN: 1933-0707; 1933-0715
• DOI: 10.3171/2016.7.PEDS1677

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.