Kidney Week

Abstract: SA-PO1012

Feline Footprints in Transplant Realms

Session Information

• Transplantation: Clinical - 4
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Sardarli, Kamil, University of California San Diego, La Jolla, California, United States

Kamil Sardarli, MD

• Del Bosque-Aguirre, Adolfo, Tecnologico de Monterrey Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, Mexico

Adolfo Del Bosque-Aguirre, MD, MS

• Mullaney, Scott, University of California San Diego, La Jolla, California, United States

Scott Mullaney, MD, MBA, FASN

Introduction

Bartonella henselae is a zoonotic pathogen with clinical presentations influenced by the immune status of the human host. While cat scratch disease is common in immunocompetent hosts, solid organ transplant recipients typically present with a different spectrum of symptoms. Bartonella species are increasingly acknowledged as significant pathogens, but diagnosing Bartonella infection in this population can be challenging due to overlapping clinical manifestations with other conditions, such as malignancy, and the potential risks associated with invasive procedures like biopsies.

Case Description

35 years old female patient presented with fever and myalgia. She had past medical history of lupus nephritis and atypical HUS complicated by end stage kidney disease and received a deceased donor kidney transplant 6 months prior to presentation, She received thymoglobulin induction and had been taking tacrolimus, mycophenolate, and prednisone for immunosuppression. On initial presentation, she was febrile (103 F), but hemodynamically stable. Initial laboratory work yielded WBC 11.6 cells/mm⁶, Hgb 7 g/dl, platelet 74/mm⁶, creatinine 1.7 g/dl from baseline 1.2 g/dl, ALP 139 U/L, ALT 39 U/L and AST 47 U/L. Initial imaging revealed an unremarkable transplant kidney but hepatosplenomegaly with multiple hypoechoic lesions throughout the liver and spleen. MRI identifed enhancing lesions in the liver, spleen, and bones with retroperitoneal lymphadenopathy, read as “primarily concerning metastatic disease with atypical infection felt to be less likely.” The patient was started on vancomycin, cefepime, metronidazole, micafungin. A broad infectious work up was ordered and interventional radiology consulted for liver biopsy. The biopsy had to be postponed by two days due to scheduling constraints. B. henselae serology returned with a positive IgM titer of 1:32 and IgG > 1:1024. She was started on azithromycin and rifampin. Further history revealed she owned three cats.

Discussion

Bartonella infection should be considered in the differential diagnosis of transplant recipients presenting with fever, lymphadenopathy and hepatosplenic lesions, especially when imaging suggests multifocal involvement. Serology offers a safer alternative to biopsy in confirming the diagnosis. Early recognition and appropriate antimicrobial therapy are crucial in managing Bartonella infection in immunocompromised hosts to prevent complications.