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Abstract: TH-PO966

Renal Manifestations Associated with Bartonella Infection

Session Information

Category: Trainee Case Report

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Mariyam joy, Christina, Washington University in St. Louis, St. Louis, Missouri, United States
  • Li, Tingting, Washington University in St. Louis, St. Louis, Missouri, United States
  • Vijayan, Anitha, Washington University in St. Louis, St. Louis, Missouri, United States
Introduction

Culture negative endocarditis constitutes about 8% of all cases. Bartonella henselae is a common causative organism. Here we discuss 3 cases of GN associated with B.henselae infections masquerading as vasculitis, IgA and focal necrotizing C3 GN.

Case Description


Case 1: A 56 y/o man with LVAD presented with SOB and AKI with rapid rise in SCr from 1 to 3.45mg/dL over 3 weeks. Lab showed positive ANA, ANCA (+PR3) and normal complements (Table). Renal pathology was highly suggestive of infection-associated GN. Additional w/u revealed B.henselae Ab IgG > 1:1024 and TEE revealed possible vegetation in RV pacemaker lead. He was treated with Doxycycline and rifampin, plus oral prednisone. F/U SCr in 1 year was 1.1mg/dL.
Case 2: A 42 y/o man with bioprosthetic AV valve presented with a vasculitis rash and AKI (SCr increased from 1.8 to 4 mg/dL). Labs showed hypocomplementemia and +ANA. Renal pathology revealed focal endocapillary proliferation with crescents. Infectious w/u revealed B.henselae and quintana IgG >1:1024, IgM >1:20. TEE revealed AV vegetation and was taken emergently for AV replacement. AV valve PCR was positive for Bartonella. Despite aggressive care post AVR, pt died on post-op day 9.
Case 3: A 64 y/o man with prosthetic MV mitral valve, was admitted for evaluation of rapidly rising SCr (1.1 mg/dL to 6 mg/dL ) over 2 wks. ANA/ANCA were neg. Renal pathology showed focal necrotizing crescentic GN with which stained for IgM, C3 and C1q. TEE showed MV vegetation and infectious w/u revealed B henselae and B quintana IgG >1:1024. He was started on HD, steroids, abx and underwent MV replacement. Pt was dialysis independent 3 mo after discharge.

Discussion

These cases demonstrate the need for high index for clinical suspicion for infectious etiology for GN in the presence of prosthetic valves or mechanical devices. Our 3 cases had very low clinical suspicion for infection at the time of initial evaluation. Serological tests and renal pathology prompted infection work up. Although all the patients had the same disease and had similar treatment, renal outcomes were very different. Awareness of Bartonella infection and early detection could have favorable patient outcomes.

CaseAge/SexCreatinine (baseline/ @Biopsy)ANAANCAC3/C4OrganismLocation of vegetationRenal biopsy: LightRenal biopsy: IFRenal biopsy: EMOutcome
156/M1/3.51:160Positive/ PR3110/19.6B.henselae IgG >1:1024RV lead of LVADFocal proliferative glomerulonephritis, Cellular crescentsC3, C1qRare mesangial electron dense deposits, mild podocyte effacementF/U Cr at 1 yr - 1.1
242/M1.8/41:160Positive (-MPO/-PR3)21/4.2B.henselae/B.quintana
IgG >1:1024 , IgM >1:20
Prosthetic AVFocal segmental endocapillary proliferation, CrescentsIgA, C3, C1qSevere podocyte effacementDeath
364/M1/6NegativeNegative70/21.8B.henselae/B.quintana IgG:1:1024Prosthetic MVFocal necrosis and crescentsIgM, C3 and C1qScattered mesangial electron dense depositsOff dialysis after 3 months
F/U Cr - 2.8