Bartonella-related multifocal bone marrow enhancement without osteolysis

Multifocal bone marrow disease due to Bartonella henselae is rare and is typically accompanied by osteolytic disease. A 10-year-old female presented with advanced disease, including prolonged fever, back pain, and radiographic multifocal pelvic bone marrow enhancement without osteolysis. Acute and convalescent serology supported the diagnosis of B. henselae infection. However, bone marrow aspirates lacked granulomas and inflammatory infiltrate. The patient fully recovered without specific antimicrobial therapy. B. henselae produces a fever and pain syndrome with multifocal bone marrow enhancement in the absence of osteolytic lesions.