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2009 Southern Regional Meeting Abstracts

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Session: Joint Plenary Poster Session and Reception

DISSEMINATED BARTONELLA HENSALAE INFECTION PRESENTING AS HISTIOCYTOSIS X
Grezaffi E, Estrada B. University of South Alabama, Mobile, AL.

Case Report: Bartonella henselae is the cause of cat-scratch disease (CSD) which has been widely associated with regional lymphadenopathy and fever of unknown origin. Numerous clinical manifestations have been reported. We describe a patient with disseminated B. henselae infection who presented with clinical manifestations suggestive of histiocytosis X. Case presentation: A 3-year old white female presented with subjective fever and areas of inflammation over her scalp and sternum noticed one day prior to admission. Additionally, she had decreased activity and oral intake. Initial skull radiographs revealed parietal and sternal lytic lesions. Laboratory studies revealed leukocytosis, anemia and hypoalbuminemia. Her C-reactive protein and erythrosedimentation rate were elevated. A human immunodeficiency virus antibody and an RPR were non-reactive. A neutrophil oxidative burst assay, myeloperoxidase stain, total complement, flow cytometry, and immunoglobulin concentrations were normal. A Mantoux intradermal test was negative. Imaging studies including CT scans of the chest and brain and a MRI of the spine were consistent with bilateral paravertebral rim-enhancing collections involving bony erosion, multiple splenic and hepatic hypoattenuations, and mottling of the T10 vertebral body. The presence of hepatosplenic lesions raised the suspicion of CSD. Histologic examination of tissue obtained during excisional biopsies of her sternal and skull lesions revealed acute and chronic inflammation. B. henseale DNA was detected by polymerase chain reaction in both tissue specimens. Subsequently, B. henselae IgG and IgM antibodies were reported positive. She received 6 weeks of antibiotic therapy including azithromycin, ciprofloxacin and trimethoprim-sulfamethoxazole. Follow-up imaging revealed complete resolution of the hepatosplenic lesions, osteomyelitis, and soft tissue masses. Discussion: This case of B. henselae infection is unique because of its clinical presentation mimicking histiocytosis X. To our knowledge there is only one previous report of such presentation. This case is evidence that disseminated B. henselae infection should be suspected in patients with subcutaneous masses associated with lytic bone lesions and hepatosplenic abscesses.


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