Abstract: TH-PO966
Renal Manifestations Associated with Bartonella Infection
Session Information
- Glomerular Trainee Case Reports
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
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.
| Case | Age/Sex | Creatinine (baseline/ @Biopsy) | ANA | ANCA | C3/C4 | Organism | Location of vegetation | Renal biopsy: Light | Renal biopsy: IF | Renal biopsy: EM | Outcome |
| 1 | 56/M | 1/3.5 | 1:160 | Positive/ PR3 | 110/19.6 | B.henselae IgG >1:1024 | RV lead of LVAD | Focal proliferative glomerulonephritis, Cellular crescents | C3, C1q | Rare mesangial electron dense deposits, mild podocyte effacement | F/U Cr at 1 yr - 1.1 |
| 2 | 42/M | 1.8/4 | 1:160 | Positive (-MPO/-PR3) | 21/4.2 | B.henselae/B.quintana IgG >1:1024 , IgM >1:20 | Prosthetic AV | Focal segmental endocapillary proliferation, Crescents | IgA, C3, C1q | Severe podocyte effacement | Death |
| 3 | 64/M | 1/6 | Negative | Negative | 70/21.8 | B.henselae/B.quintana IgG:1:1024 | Prosthetic MV | Focal necrosis and crescents | IgM, C3 and C1q | Scattered mesangial electron dense deposits | Off dialysis after 3 months F/U Cr - 2.8 |