Disseminated Bartonellosis in a Kidney Transplant Recipient Complicated by Infection-associated Glomerulonephritis: A Case Report and Literature Review

Abstract

Bartonella henselae is the causative agent of cat-scratch disease, which is characterized by self-limited regional lymphadenopathy with fever. However, visceral manifestations are possible, especially in immunocompromised patients. Here, we report a case of bartonellosis in a kidney transplant (KT) recipient complicated by glomerulonephritis (GN) associated with the infection. A 52-year-old male who received a deceased-donor KT a year earlier presented to the emergency department with fever, malaise, and abdominal pain. Maintenance immunosuppression consisted of tacrolimus, mycophenolate mofetil, and prednisone. Inguinal lymphadenopathy was found, along with generalized intra-abdominal lymphadenopathy was found. A microscopic examination of the inguinal node demonstrated necrotizing granulomas. His kidney function deteriorated, and an allograft biopsy was performed. The finding was diffuse endocapillary proliferative GN with immune complexes. The B. henselae serology results came back positive, and doxycycline and rifampin were initiated. Given the severity of the kidney injury and the imminent loss of the graft, it was decided that the patient should be treated with steroid pulses. On completion of the antibiotic therapy, his lymphadenopathy resolved. His kidney function gradually recovered, and the patient was no longer dependent on dialysis. Bartonellosis is rare in KT recipients. To our knowledge, there are no other reports of infection-associated GN caused by bartonellosis in KT recipients. Nevertheless, numerous parainfectious immune disorders have been reported in association with Bartonella infections. B. henselae infections should be considered in KT recipients presenting with fever and lymphadenopathy, and also in those presenting with cryptogenic parainfectious manifestations like GN.