B artonella henselae infection‐associated vasculitis and crescentic glomerulonephritis leading to renal allograft loss

• Published in: Transplant infectious disease 2015-06, Vol.17 (3), p.411-417
• Main Authors: Chaudhry, A.R., Chaudhry, M.R., Papadimitriou, J.C., Drachenberg, C.B.
• Format: Article
• Language: English
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12376

Bartonella henselae ( BH ) is the main cause of cat scratch disease ( CSD ), which more typically presents as a self‐limited localized suppurative lymphadenopathy in immunocompetent individuals. In contrast, immunocompromised patients commonly have systemic disease with life‐threatening complications. In addition to the angioproliferative lesions, such as bacillary angiomatosis, an increasing number of immune post‐infectious complications are being recognized with BH infections, including glomerulonephritis, vasculitis, hemophagocytic syndrome, and neurological problems. We report the case of a renal transplant recipient who developed CSD in the second year post transplantation. In addition to prolonged fever and generalized lymphadenopathy and splenomegaly requiring differentiation from a post‐transplant lymphoproliferative disorder, the course was complicated by the development of dermal leukocytoclastic vasculitis and pauci‐immune necrotizing and crescentic glomerulonephritis, which led to failure of the renal graft. Glomerulonephritis as a complication of CSD has never been described in a kidney allograft, to our knowledge. Awareness of the diverse clinical symptoms associated with BH , including granulomatous/suppurative lesions and other less common complications can lead to more rapid and accurate diagnosis. Also, as recommended by the current guidelines, a thorough history of pet ownership should be part of the clinical evaluation before and after transplantation for all transplant recipients.