Clinical and Radiologic Manifestations of Cat-Scratch Osteomyelitis in Children

Abstract

BackgroundOsteomyelitis (OM) is a rare sequela of cat scratch disease (CSD), often with atypical bone involvement. Clinical presentation of CSD OM is not well described. We sought to determine the clinical and radiologic manifestations of CSD OM patients admitted to Nationwide Children’s Hospital.MethodsEMR of inpatients was reviewed between January 2010 and March 2017. Clinical, radiological, and histopathological findings were collected.ResultsNine patients with positive cat scratch serology and/or tissue PCR were identified. Mean age was 6 years and 8 months (range 3–12 years). Patients had a prolonged course of illness before the diagnosis was made (mean 9.7 days). All patients had fever and affected bone area pain. Patients had normal WBC (mean 11,800/mm3) and modest ESR (mean 53.2 mm/hours) and CRP (mean 5.2 mg/dl) elevations on admission. Six patients had osteomyelitis at ≥ 2 sites (multifocal) with no contiguous lymphadenopathy (LAD). The vertebrae and pelvic girdle were the most common sites. Two patients had contiguous paraspinal abscesses, and 1 patient had a concomitant lymph node (LN) abscess. No osteolytic lesions were identified. Serology in all (9 of 9 IgG, 7 of 9 IgM) and PCR of bone in 2 of 2 patients were positive. All patients received antimicrobial therapy with median duration of 28 days (IQR 15–50).PatientLiver, spleen, LADVertebra/ spine/pelvisLong bonesOther bonesTreatmentTreatment before admission evaluation1Liver, Left axillary LADT7, S2, ischiumFemur, tibiaSkull base, 11th rib sternum,Rifampin (R), doxycycline (D)2Bilateral inguinal LADT3–5, T12, L1–2, S1, acetabulumR, DR, Azithromycin (A)3L2AA4Paraspinal and epidural abscess, inguinal LADT8, T11R, DA5Contiguous LAD with abscessHumerusTMP/SMX (T), RA6Left inguinal LAD, small liver and spleen lesionsT11, S1–4T, R, ciprofloxacin (C)C, R, A7Psoas muscle, paraspinal abscessL3, L5, S1, sacroiliitis4thribCT, R8NoT3A9NoIschiumFemurA, RConclusionCSD OM has an indolent course of illness with moderate elevation of inflammatory markers. Unlike previous reports of CSD and other bacterial OM, multifocal osteomyelitis without contiguous LN involvement was common. Despite significant variations in treatment duration and antimicrobial therapy choices, all patients had clinical resolution of their CSD-associated disease.Disclosures All authors: No reported disclosures.