Vertebral osteomyelitis and paraspinal abscess in an 11 yr-o
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Published in the Paediatric Infectious Disease Journal, the authors report the case of an 11-year-old immunocompetent patient presenting with a 2-week history of upper back pain, diagnosed with thoracic vertebral osteomyelitis and a paraspinal abscess caused by Bartonella henselae.

He was treated with gentamicin and doxycycline followed by oral rifampicin and doxycycline with favorable outcome.

A previously healthy 11-year-old immunocompetent male presented to the orthopedics department with a 2-week history of lower thoracic spine pain. There was no history of trauma or recent infection, and it was indicated that the complaint evolved progressively over a few days. The pain was originally considered to be of muscle origin and was offered pain relief and bed rest.

Four days later, he re-presented with low-grade fever (up to 38.5°C), no rigors, but with worsening back pain that was now radiating to the anterior left hemithorax. The patient was admitted under the orthopedic team for evaluation and treatment.

A bone scan was scheduled, and empiric therapy for possible vertebral osteomyelitis/discitis was initiated with intravenous clindamycin. A Tc99 hydroxymethylene diphosphonate (HDP) bone scan revealed an abnormal enhancement at the T7 vertebral body suggesting possible bacterial osteomyelitis. Treatment continued with the same antibiotic, but although the patient was clinically better on day 6 of therapy (less pain on palpation), fever continued.

On repeat questioning, it was revealed that the patient had frequent contact and abrasions from kittens, and he was occasionally consuming unpasteurized dairy products. No other risk factors were identified. Examination still revealed the localized tenderness on the paraspinal area.

Because of these findings, a magnetic resonance imaging (MRI) scan of the spine was requested, and serology for Bartonella species, Brucella melitensis, and a tuberculin skin test for tuberculosis was performed.

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