title: BartonellaEndocarditis and Pauci-Immune Glomerulonephritis: A Case Report and Review of the Literature.
abstract: Among culture-negative endocarditis in the United States,Bartonellaspecies are the most common cause, withBartonella henselaeandBartonella quintanacomprising the majority of cases. Kidney manifestations, particularly glomerulonephritis, are common sequelae of infectious endocarditis, with nearly half of allBartonellapatients demonstrating renal involvement. Although a pauci-immune pattern is a frequent finding in infectious endocarditis-associated glomerulonephritis, it is rarely reported inBartonellaendocarditis. Anti-neutrophil cytoplasmic antibody (ANCA) positivity can be seen with many pathogens causing endocarditis and has been previously reported withBartonellaspecies. In addition, ANCA-associated vasculitis can also present with renal and cardiac involvement, including noninfectious valvular vegetations and pauci-immune glomerulonephritis. Given the overlap in their clinical presentation, it is difficult to differentiate betweenBartonellaendocarditis and ANCA-associated vasculitis but imperative to do so to guide management decisions. We present a case of ANCA-positiveBartonellaendocarditis with associated pauci-immune glomerulonephritis that was successfully treated with medical management alone.
authors.affiliation: Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC.
authors.forename: Jillian E
authors.initials: JE
authors.lastname: Raybould
authors.affiliation: Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC.
authors.forename: Alison L
authors.initials: AL
authors.lastname: Raybould
authors.affiliation: Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC.
authors.forename: Megan K
authors.initials: MK
authors.lastname: Morales
authors.affiliation: Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC.
authors.forename: Misbah
authors.initials: M
authors.lastname: Zaheer
authors.affiliation: Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Lipkowitz
authors.affiliation: Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC.
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Timpone
authors.affiliation: Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Infectious Diseases and Travel Medicine, Washington, DC; †The University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC; and ‡Medstar Georgetown University Hospital, Georgetown University School of Medicine, Division of Nephrology and Hypertension, Washington, DC.
authors.forename: Princy N
authors.initials: PN
authors.lastname: Kumar
keywords: Bartonella endocarditis; culture-negative endocarditis; endocarditis-associated glomerulonephritis; pauci-immune glomerulonephritis