12 years old female school, from Colonia.
She had hypothyroidism diagnosed at 8 years of age, treated with levothyroxine (75 mg/day), currently with normal thyroid function.
Good growth and development.
Complete immunisations according to the national programme.
Epidemiological history: contact with cats.
She was admitted with a history of 10 days of febrile evolution, up to 40 °C axillary, daily, predominantly morning, myalgia and headaches, with no other symptoms.
Physical examination showed good general health and fever of 40 °C axillary.
A pustule was described in the third finger of the left hand and an ipsilateral axillary lymphadenopathy of 3 x 2 cm, painful, mobile, firm.
Point shock at the 5 intercostal space, midclavicular line, regular rhythm of 110/min, systolic murmur 3/6 at the apex, without irradiation.
Normal payment
Blood pressure 100/60 mmHg
Slight enlargement.
The rest of the physical examination was normal.
Laboratory tests: leukocytes 5200/mm3 (segmented 63%, lymphocytes 35%), hemoglobin 11.6 g/dl, hematocrit 38%, normal platelets; ESR 18 mm/h and hemocultives (2) negative.
Abdominal ultrasound showed enlarged spleen (10 cm) with multiple hypoechoic images of 3 to 4 mm c/u.
Electrocardiogram and Doppler echocardiogram were normal.
Treatment with 10 mg/kg/day v/ tape was indicated for 5 days and the patient was discharged 48 hours later.
Febrile persisted during the evolution.
On the 9 day, severe pain was added to the greater trochanter of the left shoulder and a painful tumor of 7 cm in the left rib seat.
She was readmitted with the following laboratory parameters: leukocytes 6,800/mm3 (60% neutrophils), hemoglobin 12.6 g/dl, platelets 413,000/mm3; C-reactive protein (CRP) 47.5 mg/1.
Abdominal ultrasound showed mild enlargement (12 cm) with multiple rounded hypoechogenic images up to 6 mm in diameter; mild hepatomegaly.
Bone scintigraphy showed increased uptake in the shoulder, hip joint, left sacroiliac joint and left ascending ramus of the lower jaw.
A CT scan of the chest showed segmental destruction of the 7th rib, with an area of osteolysis and central calcification.
Specific serology for B. henselae by indirect immunofluorescence performed at Dr. Ricardo Gutiérrez Children's Hospital in Buenos Aires was positive (IgG > 164/256, IgM cut-off).
The rib biopsy showed a chronic inflammatory process with necrotizing granulomas.
Warthin-Starry staining allowed the identification of bacilli with morphology compatible with B. henselae.
He was treated with ciprofloxacin 20 mg/kg/day i/v for 11 days plus rifampicin 10 mg/kg/day v/or for 16 days, and analgesia with metamizoly tramadol.
She remained febrile for 42 days.
Bone pain and joint functional limitation returned within 18 days.
The patient was discharged with good general condition, malaise and no sequelae.
