RESUMO
Fever, headache, myalgias and lymphadenopathy are characteristic manifestations of cat-scratch disease but other less common findings are described in 2 to 10% of cases. We report two children that presented with hepatosplenic abscesses and bone involvement. One child, had multiple areas of increased uptake in the bone scintigram with a positive serology (IgG > 1/256, IgM slightly positive). The second child had destruction of the L2 vertebral body that compromised the channel and right foramen as visualized by MRI. In both cases, bacilli were observed in the bone biopsy by Warthing-Starry stain.
Assuntos
Bartonella henselae/isolamento & purificação , Doenças Ósseas Infecciosas/etiologia , Doença da Arranhadura de Gato/complicações , Adolescente , Doenças Ósseas Infecciosas/diagnóstico , Doença da Arranhadura de Gato/diagnóstico , Criança , Feminino , Humanos , MasculinoRESUMO
Fever, headache, myalgias and lymphadenopathy are characteristic manifestations of cat-scratch disease but other less common findings are described in 2 to 10 percent of cases. We report two children that presented with hepatosplenic abscesses and bone involvement. One child, had múltiple áreas of increased uptake in the bone scintigram with a positive serology (IgG > 1/256, IgM slightly positive). The second child had destruction of the L2 vertebral body that compromised the channel and right foramen as visualized by MRI. In both cases, bacilli were observed in the bone biopsy by Warthing-Starry stain.
Las manifestaciones clínicas clásicas de la enfermedad por arañazo de gato (EAG) incluyen fiebre, cefaleas, mial-gias y adenopatía regional satélite al sitio de inoculación. En 5 a s 25 por ciento de los casos se describen formas atípicas con compromiso sistémico. Se comunican dos casos de niños que ingresan por fiebre prolongada con abscesos hepato-esplénicos Ambos agregan compromiso óseo. En el primero, el cintigrama óseo mostró múltiples zonas de hipercaptación y la serología específica para Bartonella henselae fue positiva (IgG > 1/256, IgM positiva débil). En el segundo, la resonancia magnética mostró proceso sustitutivo del cuerpo de L2 con compromiso de canal y foramen derecho, con indemnidad de los discos interverte-brales. En ambos casos, en la biopsia ósea se identificaron bacilos con tinción de Warthin-Starry. Se jerarquiza la búsqueda de esta etiología en niños inmunocompetentes que se presentan con fiebre prolongada y manifestaciones atípicas.
