Presumed Bartonella-Associated Spondylodiscitis in a 3-Year-Old Child: A Case Report and Review of the Literature

Abstract

With an incidence of 0.3 per 100,000, spondylodiscitis is a rare condition in children. It is typically bacterial in origin and most commonly caused by <i>Staphylococcus aureus</i>. Bone involvement in cat-scratch disease (CSD) due to <i>Bartonella henselae</i> is exceedingly rare, occurring in only 0.17–0.27% of cases. We present the case of a 3-year-old boy with a two-week history of intermittent back pain and a recent onset fever. Initial laboratory findings were unremarkable, and MRI revealed spondylodiscitis at L3/4 without abscess formation. Empirical antibiotic treatment with ampicillin/sulbactam showed no clinical response. Serologic testing revealed a positive <i>Bartonella henselae</i> IgM (IgG negative), leading to a change in antibiotic treatment to azithromycin and rifampicin for three weeks, resulting in rapid clinical improvement. Follow-up at nine weeks showed marked clinical and radiologic improvement. Although IgM subsequently turned negative without IgG seroconversion—a pattern previously described in <i>Bartonella</i> infections—this does not exclude the diagnosis. Biopsy or tissue PCR was not performed due to the mild clinical course. A review of the literature identified 28 pediatric cases of <i>Bartonella henselae</i> spondylodiscitis, with significant variation in diagnostic and treatment approaches. This case underscores the importance of considering <i>Bartonella</i> in the differential diagnosis of pediatric vertebral osteomyelitis.