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Abstract: FR-PO437

Bordetella holmesii: A Rare Pathogen Causing Infective Endocarditis-Associated Glomerulonephritis

Session Information

  • Pediatric Nephrology - I
    November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1800 Pediatric Nephrology

Authors

  • Gavcovich, Tara Bree, Jackson Memorial Hospital, Miami, Florida, United States
  • Al Barbandi, Malek, Jackson Memorial Hospital, Miami, Florida, United States
  • Glaberson, Wendy Robin, Jackson Memorial Hospital, Miami, Florida, United States
  • Defreitas, Marissa J., Jackson Memorial Hospital, Miami, Florida, United States
  • Katsoufis, Chryso P., Jackson Memorial Hospital, Miami, Florida, United States
  • Zuo, Yiqin, Jackson Memorial Hospital, Miami, Florida, United States
  • Abitbol, Carolyn L., Jackson Memorial Hospital, Miami, Florida, United States
  • Seeherunvong, Wacharee, Jackson Memorial Hospital, Miami, Florida, United States
Introduction

Infective endocarditis (IE) can cause multiorgan failure and chronic kidney disease, in addition to cardiac sequelae. Presentation may be vague and can manifest as acute glomerulonephritis (GN). While the most common pathogens of IE are Staphylococcus and Streptococcus species, we report the rare pathogen Bordetella holmesii causing IE associated GN.

Case Description

A 20-year-old male born with pulmonary atresia and ventricular septal defect underwent corrective surgeries, and prosthetic pulmonary valve replacements at 3 and 9 years old. He was admitted to an outside hospital with fever and hematemesis, diagnosed with streptococcal pharyngitis. A month later, he presented to our institution with lower extremity edema and gross hematuria. On exam, he was afebrile, normotensive, had a 7-kg weight gain with anasarca, a loud systolic murmur, but no rash. Investigations revealed elevated serum creatinine, nephrotic proteinuria, hematuria, and hypocomplementemia, consistent with immune-mediated acute GN. Given his cardiac history, blood cultures were collected from 3 sites. Broad-spectrum antibiotics were initiated when he subsequently developed fever. Renal pathology showed IgM and C3-codominant diffuse proliferative GN (Figure). Transesophageal echocardiogram visualized a vegetation on the pulmonic valve. Bordetella holmesii was ultimately cultured from the prior and current hospitalization. A serum sample detecting microbial cell-free DNA sequencing confirmed Bordetella holmesii at very high levels. After completing 6 weeks of IV antibiotics with concurrent angiotensin receptor blockade, his kidney function recovered with improvement in hypocomplementemia and proteinuria (Table).

Discussion

This case report highlights the early recognition and comprehensive evaluation of a rare organism causing IE associated GN, which allowed for renal recovery and preserved cardiac function.

Biochemistry Progression
 NormalPresentationDay 4Week 1Week 3Week 6
Serum Creatinine (mg/dL)0.6-1.23.43.32.31.71.0
Complement C3 (mg/dL)90-1805249  87
Complement C4 (mg/dL)10-4053  15
Urine protein to creatinine ratio (mg/mg)< 0.21.91.72.66.52.2