SHM Converge Scientific Abstract ePoster Gallery-Cat's Out of the Bag: A Case of Bartonella Sacral Osteomyelitis

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A previously healthy 4-year-old boy presented with 2 weeks of fever, sacral pain, and decreased appetite after a fall. Initial evaluation for constipation and appendicitis was negative. Labs showed elevated inflammatory markers (ESR 73, CRP 8.3) and thrombocytosis, but were otherwise unremarkable. Because he appeared well, empiric antibiotics were deferred.<br /><br />MRI of the sacrum revealed ill-defined enhancing marrow infiltration of the S2 region and right iliac wing with extension into the neural foramen, raising concern for malignancy, osteomyelitis, Langerhans cell histiocytosis, or CRMO. Abdominal ultrasound also showed mild hepatosplenomegaly with multiple hypoechoic splenic lesions, further increasing concern for cancer.<br /><br />Bone marrow biopsy showed no neoplastic process, and CT-guided sacral biopsy demonstrated histiocytic proliferation with acute and chronic inflammation. Given recent travel and kitten exposure, Bartonella and TB testing were sent. Bartonella henselae serologies returned positive, confirming cat scratch disease with atypical sacral osteomyelitis.<br /><br />The patient was treated with a 4-week course of azithromycin, with improvement in fever and sacral pain and later resolution of symptoms. Follow-up imaging showed improvement in splenic lesions.<br /><br />This case highlights that Bartonella henselae infection can present atypically as bone marrow infiltration, sacral osteomyelitis, hepatosplenomegaly, and hypoechoic splenic lesions, closely mimicking malignancy on imaging. A thorough exposure history, especially kitten contact, was key to diagnosis. Sacral osteomyelitis from Bartonella is extremely rare, and there is no consensus on optimal treatment duration in pediatric cases.

Asset Subtitle

Meenu Krishnasamy

Meta Tag

Author List Katherine Moyer, Meenu Krishnasamy, Nadia Majid

Category Clinical Vignettes

Concept Bartonella henselae infection

Concept Osteomyelitis

Concept Bartonella Sacral Osteomyelitis

Concept Disseminated Bartonella infection

Concept Hepatosplenic involvement

Distinguished Non-Finalist

Presenter Organization Inova Children's Hospital

Presenting Author Meenu Krishnasamy

Track Pediatric

Keywords

Bartonella henselae

cat scratch disease

sacral osteomyelitis

pediatric infection

bone marrow infiltration

hepatosplenomegaly

splenic lesions

MRI findings

kitten exposure

azithromycin treatment

Bartonella henselae infection

Osteomyelitis

Bartonella Sacral Osteomyelitis

Disseminated Bartonella infection

Hepatosplenic involvement