Cat-scratch disease with paravertebral mass and osteomyelitis

The case of a 9-year-old girl with cat-scratch disease (CSD) complicated by development of a paravertebral mass and osteomyelitis is presented. Follow ing multiple scratches and inguinal lymphadenopathy, she developed back pai n, and imaging demonstrated a paravertebral mass with evidence of osteomyel itis involving vertebra T9. The diagnosis was made on the basis of detectio n of Bartonella henselae by use of molecular techniques on an aspirate from the vertebral column and supportive serology for infection with B. hensela e. Eleven other cases of this unusual manifestation associated with CSD hav e been reported in the literature and are reviewed. The patient was treated with gentamicin, followed by rifampicin and trimethoprim-sulfamethoxazole, orally and made a favorable recovery over 7 months. This is comparable wit h other case reports, regardless of the choice of antibiotic therapy. CSD i n immunocompetent hosts is not always self-limiting, and tissues beyond the lymph nodes can be involved.