Multi-Organ Involvement Confounding the Diagnosis of Bartonella henselae Infective Endocarditis in Children with Congenital Heart Disease.   

Ouellette CP, Joshi S, Texter K, Jaggi P.

Two children with congenital heart disease status-post surgical correction presented with prolonged constitutional symptoms, hepatosplenomegaly and pancytopenia. Concern for malignancy prompted bone marrow biopsies that were without evidence thereof. In case #1, echocardiography identified a multilobulated vegetation on the conduit valve. In case #2, transthoracic, transesophageal and intracardiac echocardiography were performed and were without evidence of cardiac vegetations, however pulmonic emboli raised concern for infective endocarditis. Both patients underwent surgical resection of the infected material and had histopathologic evidence of infective endocarditis. Further diagnostics identified elevated cytoplasmic anti-neutrophil cytoplasmic antibodies and anti-proteinase 3 antibodies in addition to acute kidney injury with crescentic glomerulonephritis on renal biopsy. Serologic evidence of infection with B. henselae was observed in both patients. These two cases highlight the potential multi-organ involvement that may confound the diagnosis of culture negative infective endocarditis due to B. henselae.
PMID: 28027277 DOI: 10.1097/INF.0000000000001510

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