Abstract: PO2464
Bacillary Angiomatosis in a Kidney Transplant Recipient
Session Information
- Transplant Complications: Infection
October 22, 2020 | Location: On-Demand
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1902 Transplantation: Clinical
Authors
- Hassanein, Mohamed, Cleveland Clinic, Cleveland, Ohio, United States
- Syed, Bushra, Cleveland Clinic, Cleveland, Ohio, United States
- Morillas, Jose, Cleveland Clinic, Cleveland, Ohio, United States
- Lum, Jessica M., Cleveland Clinic, Cleveland, Ohio, United States
- Liaqat, Aimen, Cleveland Clinic, Cleveland, Ohio, United States
- Bergfeld, Wilma F., Cleveland Clinic, Cleveland, Ohio, United States
- Sardina, Luis Antonio, Cleveland Clinic, Cleveland, Ohio, United States
- Fatica, Richard A., Cleveland Clinic, Cleveland, Ohio, United States
Introduction
Bacillary angiomatosis (BA) is a vascular proliferative manifestation of Bartonella henselae (BH) or Bartonella quintana (BQ) that usually affects immunocompromised hosts. It usually involves the skin but may affect other organs. Few cases of BA in kidney transplant (KT) recipients have been reported, with most cases presenting years after KT. We describe a case of BA in a KT recipient that occurred early post-transplant.
Case Description
A 67-year-old male KT recipient from a deceased donor developed fevers, night sweats, and fatigue 1-month post-KT. He received antithymocyte globulin induction, and maintenance tacrolimus, mycophenolate, and prednisone. Two months later, he presented with diffuse violaceous papules (Figure 1A). Biopsy of a papule with Warthin-Starry stain showed clusters of bacteria suggestive for BA (Figure 1B). Diagnosis was confirmed with a positive serum Bartonella polymerase chain reaction (PCR). He was treated with doxycycline with resolution of symptoms. BH and BQ Immunoglobulin G (IgG) were equivocal. A few weeks later, IgG for BH was 1:256 (reference range <1:128). Echocardiogram, abdominal computed tomography, and kidney biopsy were unremarkable. Recipient Bartonella PCR and antibodies on the day of transplant were negative. Donor Bartonella PCR and BH IgG were negative. Donor BQ IgG was equivocal. The recipient had a cat 8 years prior to KT without recent exposure. Allograft function remains intact, and the rash completely resolved. Bartonella PCR 6 months on treatment was negative.
Discussion
Our patient developed signs of BA with positive seroconversion within the first 3 months of KT which is rare. BA should be considered in the differential diagnosis of fever and cutaneous angioma-like lesions in KT recipients, even in the absence of exposures. Combined serology and molecular testing (PCR) is useful in diagnosing BA as serology alone may be unreliable. Early empiric treatment should be considered in transplant recipients while waiting for confirmatory results.
Figure 1. (A) Violaceous papules on the trunk. (B) Warthin–Starry stain showing bacteria (arrow).