The Pediatric Infectious Disease Journal. 36(5):516-520, MAY 2017

Christopher P Ouellette; Sarita Joshi; Karen Texter; Preeti Jaggi


Two children with congenital heart disease status post surgical correction presented with prolonged constitutional symptoms, hepatosplenomegaly (simultaneous enlargement of both the liver (hepatomegaly) and the spleen (splenomegaly) and pancytopenia (decrease in red blood cells, white blood cells and platelets).

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 antineutrophil cytoplasmic antibodies and antiproteinase 3 antibodies in addition to acute kidney injury with crescentic glomerulonephritis on renal biopsy. Serologic evidence of infection with Bartonella henselae was observed in both patients. These 2 cases highlight the potential multiorgan involvement that may confound the diagnosis of culture-negative infective endocarditis caused by B. henselae.

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