Rozmanic Vojko, Banac Srdjan, Miletic Damir, Manestar Koraljka, Kamber Silvija, Paparic Sime
Department of Pediatrics, University of Rijeka, Rijeka, Croatia.
J Paediatr Child Health. 2007 Jul-Aug;43(7-8):568-70. doi: 10.1111/j.1440-1754.2007.01141.x.
Cat-scratch disease (CSD) is a self-limiting infectious disease characterised with lymphadenopathy in a patient with a history of cat contact. Cases of bone involvement in patients with CSD are rare. We reported a case of 11-year-old boy with prolonged intermittent fever, inguinal lymphadenopathy and osteomyelitis. He had a history of exposure to kittens. The physical examination revealed a febrile boy without an apparent site of infection except an enlarged inguinal lymph node. Its histopathology demonstrated granulomatous lesion with no presence of acid-fast bacilli. Serum titers for Bartonella henselae were positive. Multiple bone lesions were detected by skeletal scintigraphy. Magnetic resonance imaging (MRI) confirmed and characterised osteolytic masses. The oral combination of azithromycin and rifampicin were given for 6 weeks with a good clinical response. At follow-up, the boy was without symptoms or signs of the disease. Successive MRI controls showed gradual regression of the bone lesions together with significant decrease of acute-phase reactants. In conclusion, CSD should be considered in the differential diagnosis of osteomyelitis. MRI is more reliable for the characterisation, evaluation of soft-tissue extension and follow-up of the bone lesions than scintigraphy. However, the later method permits an overview of the multiple osseous lesions. Therefore, standard MRI equipment may not exclude bone scintigraphy. Both methods are required until whole-body MRI units become routine.
猫抓病（CSD）是一种自限性传染病，其特征为有猫接触史的患者出现淋巴结病。CSD患者出现骨骼受累的病例罕见。我们报告了一例11岁男孩，有长期间歇性发热、腹股沟淋巴结病和骨髓炎。他有接触小猫的病史。体格检查发现该发热男孩除腹股沟淋巴结肿大外无明显感染部位。其组织病理学显示为肉芽肿性病变，无抗酸杆菌。汉赛巴尔通体血清滴度呈阳性。骨骼闪烁扫描检测到多处骨病变。磁共振成像（MRI）证实并确定了溶骨性肿块的特征。给予阿奇霉素和利福平口服联合治疗6周，临床反应良好。随访时，该男孩无疾病症状或体征。连续的MRI检查显示骨病变逐渐消退，急性期反应物显著减少。总之，在骨髓炎的鉴别诊断中应考虑CSD。与闪烁扫描相比，MRI在骨病变的特征描述、软组织扩展评估和随访方面更可靠。然而，后一种方法可以对多处骨病变进行总体观察。因此，标准的MRI设备可能不能排除骨闪烁扫描。在全身MRI设备成为常规检查之前，两种方法都需要。
