Abstract: SA-PO940
Disseminated Bartonellosis Masquerading as PTLD in a Renal Transplant Recipient
Session Information
- Fellows/Residents Case Reports: ESRD: HD, PD, Transplant
November 04, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Nephrology Education
- 1302 Fellows and Residents Case Reports
Authors
- Tandukar, Srijan, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania, United States
- Wu, Christine, University of Pittsburgh Medical Center , Pittsburgh, Pennsylvania, United States
Background
A solid organ transplant recipient is at high risk for infections due to immunosuppression. We report a case of a renal transplant recipient presenting with diffuse lymphadenopathy concerning for PTLD who was found to have disseminated bartonellosis.
Methods
A 32 year old male presented 11 months following his renal transplant (CMV +/-, EBV +/+) with complaints of malaise, drenching night sweats and fever to 101.8 F while on tacrolimus and mycophenolate mofetil. Review of systems was positive for a cat scratch on his knee several months back. He was hemodynamically stable on presentation. On exam, he had tender right inguinal lymphadenopathy. Urinalysis, chest x-ray and blood cultures were negative. His WBC count was 6,700/mm3 and creatinine was 1.6 mg/dl (baseline 1.2 mg/dl). CT scans showed left supraclavicular, axillary, retroperitoneal and iliofemoral lymphadenopathy with hypodense lesions in the liver, spleen and renal allograft. PCR showed 110 copies/ml EBV and no CMV. Serologies for Bartonella henselae were positive for IgG (1:512) and IgM (1:80). Lymph node biopsy showed necrotic areas, neutrophilic abscesses with focal positivity for Bartonella and large abnormal cells that were EBV positive. He was treated with azithromycin and doxycycline for 8 weeks. His symptoms, along with lymphadenopathy, splenic and liver lesions on repeat CT scan resolved completely. His creatinine stabilized at 1.5-1.7 mg/dl.
Conclusion
PTLD is characterized by lymphoid proliferation of B cells that may be monoclonal or polyclonal in origin and affects up to 1-2% of kidney transplant patients. As in our case, patients with PTLD often present with fever, malaise and lymphadenopathy. Bartonella henselae is a bacterium that is transmitted from cats to humans from a scratch or bite. Infected patients often present with fever, lymphadenopathy and night sweats. Dermatologic and neurologic findings may also be present. In an immunocompromised patient, the features may be more severe, with dissemination to other organs. In our patient, complete resolution of symptoms and CT findings following antibiotic treatment confirmed the diagnosis of bartonellosis. Disseminated bartonellosis should be considered in transplant patients presenting with fever and lymphadenopathy.