Multifocal Osteomyelitis in an Adolescent Patient With Cat Scratch Disease.

IF 1 Q4 INFECTIOUS DISEASES
Case Reports in Infectious Diseases Pub Date : 2024-09-07 eCollection Date: 2024-01-01 DOI:10.1155/2024/9562634
Burcu Topçu, Hale Usluer Gönüllü, Osman Yeşilbaş, Pınar Polat Suma, Ahmet Soysal
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Abstract

Cat scratch disease (CSD) typically presents as a self-limiting lymphadenopathy associated with a cat bite or scratch and commonly affects children and young adults. Atypical manifestations, involving the eyes, nervous system, heart, liver, spleen, skin, and musculoskeletal system, could be severe and difficult to diagnose, and they could occur in 5%-20% of the cases. Herein, we report an unusual case of CSD with multifocal osteomyelitis. A 15-year-old girl presented with right axillary lymphadenopathy. Since she had a history of cat scratch, azithromycin was started for CSD. Two days later, she was readmitted to our hospital with severe back pain which required differential diagnosis. Lumbar spinal magnetic resonance imaging (MRI) revealed multifocal vertebral osteomyelitis. The patient was hospitalized, and then teicoplanin and cefotaxime were added to the azithromycin therapy. After excluding the possible other causes, the definitive diagnosis of osteomyelitis secondary to CSD was made upon the combination of the MRI scan findings of the vertebrae, histopathological investigation of excisional right axillary biopsy, positron-emission tomography/computed tomography (PET/CT), and Bartonella henselae serologies. Atypical manifestations of CSD are widely variable; therefore, it should be kept in mind in the differential diagnosis of severe musculoskeletal pain and osteomyelitis.

一名青少年猫抓病患者的多灶性骨髓炎
猫抓病(CSD)通常表现为与猫咬伤或抓伤相关的自限性淋巴结病,常见于儿童和青壮年。非典型表现可累及眼睛、神经系统、心脏、肝脏、脾脏、皮肤和肌肉骨骼系统,病情严重且难以诊断,约占病例总数的5%-20%。在此,我们报告了一例不同寻常的 CSD 合并多灶性骨髓炎病例。一名 15 岁女孩因右腋窝淋巴结肿大就诊。由于她有猫抓病病史,医生开始使用阿奇霉素治疗 CSD。两天后,她因剧烈背痛再次入院,需要进行鉴别诊断。腰椎磁共振成像(MRI)显示她患有多灶性脊椎骨髓炎。患者住院后,在阿奇霉素治疗的基础上加用替考拉宁和头孢他啶。在排除了其他可能的病因后,结合椎体的核磁共振扫描结果、右腋窝切除活检的组织病理学检查、正电子发射断层扫描/计算机断层扫描(PET/CT)和鸡巴氏杆菌血清学检查,最终确诊为继发于 CSD 的骨髓炎。CSD 的非典型表现千变万化;因此,在鉴别诊断严重肌肉骨骼疼痛和骨髓炎时应牢记这一点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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审稿时长
13 weeks
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