SHM Converge Scientific Abstract ePoster Gallery-A Catchy Case of Osteomyelitis

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A previously healthy 9-year-old girl presented with 10 days of daily fevers and right lower quadrant abdominal pain while taking amoxicillin for a recent group A strep infection. She had no headache, vomiting, hip pain, trauma, or obvious joint findings. Exposure history included two dogs and a cat that intermittently returned to the home.<br /><br />Initial evaluation showed fever, tachycardia, tachypnea, and bilateral lower abdominal tenderness, but normal hip range of motion and no skin changes or lymphadenopathy. Labs revealed elevated inflammatory markers (CRP 4.6 mg/dL, ESR 60 mm/hr), mild anemia, and negative urine, blood, and monospot testing. Bartonella henselae serology was strongly positive, with IgM 1:512.<br /><br />Appendicitis was initially suspected, but ultrasound could not visualize the appendix, and MRI of the appendix showed no appendicitis. Instead, MRI demonstrated marrow edema and enhancement in the right ilium, consistent with osteomyelitis, without abscess. A dedicated hip/pelvis MRI confirmed right iliac osteomyelitis.<br /><br />She was diagnosed with Bartonella henselae osteomyelitis, an uncommon form of atypical cat-scratch disease. After consultation with pediatric infectious disease, she was treated with IV cefazolin and improved clinically, with resolution of abdominal pain and normalization of inflammatory markers. She was discharged on oral cephalexin to complete a 5-week antibiotic course and was doing well at follow-up.<br /><br />This case highlights that Bartonella henselae can cause disseminated disease beyond classic lymphadenopathy, including osteomyelitis. Because exposure history may be subtle or absent, clinicians should maintain a high index of suspicion in children with unexplained fever, vague pain, and inflammatory markers suggesting infection.

Asset Subtitle

Ayushi Kaul

Meta Tag

Author List Allison Ashford, Ayushi Kaul, Kelli D. Mans, Terri Love

Category Clinical Vignettes

Concept Bartonella henselae

Concept Pediatric osteomyelitis

Concept Disseminated infection

Concept Inflammatory Markers

Concept Serology

Distinguished Non-Finalist

Presenter Organization Creighton University School of Medicine

Presenting Author Ayushi Kaul

Track Pediatric

Keywords

Bartonella henselae

osteomyelitis

cat-scratch disease

pediatric fever

right lower quadrant pain

iliac osteomyelitis

MRI diagnosis

inflammatory markers

atypical infection

antibiotic treatment

Bartonella henselae

Pediatric osteomyelitis

Disseminated infection

Inflammatory Markers

Serology