Multifocal osteomyelitis in a child: a rare manifestation of cat scratch disease

We present a case of a 9-year-old immunocompetent girl who presented with pain in her left elbow and a painful swelling at her left clavicle. She had no lymphadenopathy or fever. Four hot spots were seen at her left clavicle, proximal and distal left humerus and lumbo-sacral spine on a bone scan. A magnetic resonance imaging showed an inflammatory process with bone destruction at her clavicle. Serological testing and polymerase chain reaction performed on a bone biopsy identified a Bartonella henselae infection. She was treated with rifampin and trimethoprim-sulphamethoxazole. After a relapse half a year later, the patient recovered fully. Multifocal osteomyelitis is a rare manifestation of cat scratch disease in children.