title: Bartonella henselae infection-associated vasculitis and crescentic glomerulonephritis leading to renal allograft loss.
abstract: 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.
authors.affiliation: Department of General Surgery, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Chaudhry
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Chaudhry
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Papadimitriou
authors.affiliation: Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: C B
authors.initials: CB
authors.lastname: Drachenberg
mesh_terms: D018416:Bartonella henselae / Q000502:physiology*; D002372:Cat-Scratch Disease / Q000150:complications*; D005260:Female; D005921:Glomerulonephritis / Q000209:etiology* / Q000473:pathology; D006801:Humans; D016867:Immunocompromised Host; D016030:Kidney Transplantation; D008875:Middle Aged; D014657:Vasculitis / Q000150:complications*
keywords: ANCA; Bartonella henselae; cat scratch disease; kidney transplant; lymphadenopathy; necrotizing glomerulonephritis; pauci-immune glomerulonephritis; post-infectious complications; post-transplant lymphoproliferative disorder; rapidly progressive glomerulonephritis; rejection; renal biopsy; skin biopsy; solid organ transplant; vasculitis