Acute antibody titers for Bartonella henselae IgG and IgM were both reactive at 1:1024 and 1:80, respectively. After an uneventful postoperative course, the child was discharged home to complete a 3-week course of azithromycin, pending investigations for CSD. The patient underwent surgical drainage of the right middle finger and right axillary abscess. According to her, the cat did not scratch the child but licked the hand. On further questioning, the mother remembered that the child had played with a stray kitten a few days after her finger injury. Oral azithromycin (5 mg/kg/d) was added to the treatment. An axillary ultrasonogram revealed multiple necrotic lymph nodes with hypoechoic central areas, consistent with an abscess. An MRI scan of the finger showed signs of bone destruction and a small abscess in the tuft of the distal phalanx. Laboratory results showed a white blood cell count of 14,800/µL, with 47% neutrophils C-reactive protein level of 21.89 mg/dL and erythrocyte sedimentation rate of 29 mm/h. The infectious diseases specialist was consulted. Empiric treatment with parenteral clindamycin was started. The presumptive diagnosis was osteomyelitis caused by Staphylococcus aureus and associated reactive lymphadenitis. Figure 1 – The tender scab with purulent drainage and mild erythema on the palmar side of the distal right middle digit developed 6 weeks after a crush injury to the finger.
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