Kidney Week

Abstract: SA-PO884

Crescentic Glomerulonephritis and Pancytopenia Secondary to Bartonella henselae Bioprosthetic Valve Endocarditis

Session Information

• Glomerular Diseases: Case Reports - 2
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Glomerular Diseases

• 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

• Salvatierra, Juan, Hamilton Medical Center, Dalton, Georgia, United States

Juan Salvatierra, MD

• Rao, Rohini, Riverview Regional Medical Center, Gadsden, Alabama, United States

Rohini Rao, MBBS

• Nasri, Rasha, Hamilton Medical Center, Dalton, Georgia, United States

Rasha Nasri, MD

• Harris, Liliia, Hamilton Medical Center, Dalton, Georgia, United States

Liliia Harris, MD, MEd

• Alayyat, Ahmad, Hamilton Medical Center, Dalton, Georgia, United States

Ahmad Alayyat, MD

• Tuel, Keelan T., Hamilton Medical Center, Dalton, Georgia, United States

Keelan T. Tuel, MD, MBA

• Duchesne, Rafael O., Hamilton Medical Center, Dalton, Georgia, United States

Rafael O. Duchesne, MD

• Connor, Lee, Hamilton Medical Center, Dalton, Georgia, United States

Lee Connor, MD

Introduction

Bartonella spp may cause diverse clinical manifestations including endocarditis and cytopenias. The new 2023 Duke-ISCVID criteria include Bartonella serology as this infection is often culture-negative. Infection-related glomerulonephritis (IRGN) can be secondary to Bartonella endocarditis and usually has an immune-complex deposition pattern.

Case Description

A 53-year-old man with insulin-dependent type 2 diabetes presented to the emergency department with epistaxis, abdominal pain and vomiting for three days. He noted 7-pound weight loss and a leg rash for three weeks. He owns cats. He denied fever or joint swelling. He had undergone bioprosthetic valve replacement for mitral valve prolapse 5 years before.

Examination revealed a petechial and purpuric rash on his lower extremities but no heart murmur or lymphadenopathy. Laboratory analyses showed pancytopenia, creatinine 11 mg/dL, 3+ hematuria and proteinuria, and negative ANA and ANCA. Kidney biopsy revealed crescentic glomerulonephritis with codominant IgM and C3 deposits. Hemodialysis was initiated for worsening renal function. Due to negative blood cultures and no vegetation on echocardiogram, he received rituximab and methylprednisolone. Expanded infectious workup returned positive for B. henselae titers IgM 1:20 and IgG >1:1024. He was started on doxycycline 100 mg twice daily indefinitely and rifampin 300 mg for 2 weeks and discharged home on a steroid taper.

Discussion

Crescent formation may be indicative of IRGN and should prompt extensive testing if no causative organism is initially identified. We present a rare case of B. henselae causing endocarditis, glomerulonephritis, and pancytopenia. Although there are no guidelines for the treatment of B. henselae bioprosthetic valve endocarditis, treatment with doxycycline and rifampin followed by permanent suppressive treatment with doxycycline may be reasonable.