Kidney Week

Abstract: SA-PO1166

A Quint-Essential Diagnosis

Session Information

• Transplantation: Clinical - Infectious Diseases
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2002 Transplantation: Clinical

Authors

• Malik, Mahad, Thomas Jefferson University, Philadelphia, Pennsylvania, United States

Mahad Malik, MD

• Verma, Yogesh, Thomas Jefferson University, Philadelphia, Pennsylvania, United States

Yogesh Verma, MD

• Gupta, Maitreyee M., Thomas Jefferson University, Philadelphia, Pennsylvania, United States

Maitreyee M. Gupta, MD

• Gulati, Rakesh, Thomas Jefferson University, Philadelphia, Pennsylvania, United States

Rakesh Gulati, MD, FASN

• Martinez Cantarin, Maria P., Thomas Jefferson University, Philadelphia, Pennsylvania, United States

Maria P. Martinez Cantarin, MD, MS, FASN

• Shenoy, Prashamsa, Thomas Jefferson University, Philadelphia, Pennsylvania, United States

Prashamsa Shenoy, MD

Introduction

Febrile rash post-kidney transplant (KT) requires rapid etiologic clarification. Differential for non-blanchable papular rash (0–6 months) includes Kaposi Sarcoma (KS) or disseminated infection. Bacillary Angiomatosis (BA) is a rare mimic. Identification is critical as induction immunosuppression (IS) "opens the flood gates" for pathogens not covered by standard prophylaxis, requiring a balance between IS intensity and targeted antimicrobial therapy.

Case Description

A 62yo Afro-Haitian male received his first deceased-donor KT. Induction: anti-thymocyte globulin (2mg/kg x3). Maintenance: tacrolimus (trough 8–11ng/mL), mycophenolate 750mg BID, steroids. Prophylaxis: valganciclovir, trimethoprim-sulfamethoxazole. 4mo post-KT: fever, 13.6kg weight loss, diffuse non-blanchable rash. Labs: CMV (7,270IU/mL), BK (12,500IU/mL) viremia. CT: 2.8x1.7cm hepatic hypodensity. Biopsy suggested BA. Despite no feline/personal homelessness exposure, UNOS review revealed donor homelessness—a risk for Bartonella quintana. This enabled a "Quint-essential" diagnostic pivot. Doxycycline was started; ganciclovir maintained.

Discussion

BA mimics KS or CMV. Identifying donor risk via UNOS is vital for B. quintana, an emerging donor-derived threat. Bartonella is fastidious, failing automated cultures (requires 45-day incubation). PCR and serology are mainstays, though induction IS can blunt antibody kinetics, yielding negative early tests. Standard prophylaxis is ineffective. Evaluate for disseminated features (peliosis hepatis/osteitis) and consider Torquetenovirus (TTV) to stratify IS status.

A: Diffuse, non-blanchable maculonodular rash across the trunk, raising concern for malignancy.
B: Extremity Involvement: Multiple raised, dark-pigmented papules on the forearm.
C: Lesion Morphology: Close-up of a friable, angiomatous nodule, a hallmark of Bartonella-induced vascular proliferation.
D: Dermoscopic Detail: Magnified view highlighting the vascular architecture that prompted the biopsy.