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Abstract: SA-PO886

A Genuine Cat's Cradle: An Elusive Case of Bartonella Endocarditis-Associated Glomerulonephritis

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics

Authors

  • Ahmed, Sameer, University of Kentucky College of Medicine, Lexington, Kentucky, United States
  • Allen, Patricia J., Veterans Administration Hospital, Lexington, Kentucky, United States
  • Cornea, Virgilius, University of Kentucky, Lexington, Kentucky, United States
Introduction

We present a 73 yo male patient with Bartonella endocarditis–associated GN. The following describes his initial presentation, the ensuing diagnostic dilemma, and the eventual diagnosis which lead to proper resolution of the infection but unfortunate permanent loss of the patient's kidney function.

Case Description

1 year after recieving a prosthetic aortic valve, a 73 yo male began developing weight loss, fatigue, and pancytopenia. The patient's pancytopenia and 80lb weight loss led to a malignancy workup that was non-revealing. After 6 months of worsening symptoms the patient was admitted with progressive kidney dysfunction and hematuria. Serological workup revealed low C3 & C4, +ANA, +dsDNA, +PR3, and an RF titer of >256. This led to an initial impression of lupus nephritis. However, a kidney biopsy revealed either infection-related GN or C3 nephritis.The patient's blood cultures were negative for typical organisms, but a TEE showed vegetation in the aortic valve. A search for atypical organisms revealed a Bartonella henselae IgG titer >1.256 and an IgM titer >1.800. As renal function deteriorated the patient was started on HD. The patient was placed on a combination of Rifampin and Doxycycline for 3 months. The patient's overall condition improved except for his kidney function, which progressed to ESKD.

Discussion

B. henselae is one of the most common causes of culture-negative IE. Kidney involvement is seen in up to half of patients with IE, and these patients can exhibit hematuria, infarction of the parenchyma, and glomerulonephritis. Delays in the rapid identification of the causative organism due to a negative blood culture can confuse the differential and delay treatment. B. henselae endocarditis is most associated with an exposure to cats and pre-existing valvular disease. This patient's affection for his feline companions was to a degree that it was noted in a PCP note months prior to admission, revealing the odd ways a patient's history can illuminate etiology.