Antonson Molly, Klingemann Lauren, Neemann Kari
College of Medicine University of Nebraska Medical Center, Omaha, NE, USA.
Division of Pediatric Infectious Disease University of Nebraska Medical Center, Omaha, NE, USA.
Case Rep Infect Dis. 2024 Aug 5;2024:7810497. doi: 10.1155/2024/7810497. eCollection 2024.
is a Gram-negative bacillus transmitted to humans via cat saliva or scratch. Cat scratch disease, the typical clinical manifestation of infection, presents as localized cutaneous or regional lymphadenopathy. Rare, atypical presentations, generally reflecting bloodborne disseminated disease, can include hepatosplenic, cardiac, ocular, neurologic, or musculoskeletal involvement. Here, we present a case of disseminated with hepatic abscesses and associated ischial osteomyelitis in an immunocompetent 2-year-old male patient. Although osteomyelitis is a rare manifestation of infection, it should be included in the differential diagnosis in pediatric patients presenting with fever of unknown origin and musculoskeletal pain, especially in the setting of cat exposure. Hepatic involvement of infection is associated with significant morbidity; therefore, abdominal imaging is critical in the diagnostic workup. This patient was successfully treated after a 6-week course of azithromycin and rifampin, as evidenced by symptom resolution and improved fluid collections on repeat imaging. While most cases of resolve without treatment, in severe or disseminated infection such as this case, antibiotics such as azithromycin and rifampin should be considered for treatment.
是一种通过猫唾液或抓挠传播给人类的革兰氏阴性杆菌。猫抓病是该感染的典型临床表现，表现为局部皮肤或区域性淋巴结病。罕见的非典型表现，通常反映血行播散性疾病，可包括肝脾、心脏、眼部、神经或肌肉骨骼受累。在此，我们报告一例免疫功能正常的2岁男性患者发生播散性该病菌感染并伴有肝脓肿和相关坐骨骨髓炎的病例。虽然骨髓炎是该病菌感染的罕见表现，但在不明原因发热和肌肉骨骼疼痛的儿科患者中，尤其是在有接触猫的情况下，应将其纳入鉴别诊断。该病菌感染的肝脏受累与显著的发病率相关；因此，腹部影像学检查在诊断工作中至关重要。该患者在接受为期6周的阿奇霉素和利福平治疗后成功治愈，症状缓解以及重复影像学检查显示积液改善证明了这一点。虽然大多数该病菌感染病例无需治疗即可痊愈，但在如此严重或播散性感染的情况下，如本病例，应考虑使用阿奇霉素和利福平之类的抗生素进行治疗。
