Systemic Bartonellosis Manifesting With Endocarditis and Membranoproliferative Glomerulonephritis

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Cat scratch disease caused by Bartonella species is mostly benign and self-limiting condition. Systemic infection is uncommon in immunocompetent host. We describe the case of a 66-year-old male who presented with sudden painless left eye blindness and brown-colored urine. Laboratory findings revealed progressively rising serum creatinine in association with nephrotic-range proteinuria at 7 g/day and glomerular hematuria on urinalysis. An echocardiogram demonstrated mitral and tricuspid valve vegetations despite multiple negative blood cultures. The left eye blindness was attributed to retinal artery occlusion from septic valvular embolus. Kidney biopsy showed membranoproliferative glomerulonephritis pattern of injury with “full house” pattern on immunofluorescent staining with subendothelial deposits on electron microscopy. Markedly elevated IgG (immunoglobulin G) titers for B henselae and B quintana were discovered. The patient had several cats at home. Kidney failure rapidly progressed to require hemodialysis. Once the diagnosis of systemic bartonellosis was confirmed, doxycycline (for 4 months) with rifampicin (for 3 months) were initiated. Repeat echocardiogram in 4 months demonstrated a resolution of valvular vegetations; however, the left eye blindness was permanent. In the present case the correct diagnosis of systemic bartonellosis allowed institution of appropriate antibiotic therapy and to also achieve a partial recovery of renal function and to discontinue hemodialysis.



I must object to Bartonella being “mostly benign and self-limiting.”  Anyone who has ever had this beast will agree.  It’s not fun and it’s very tenacious.  I could rattle off over 20 cases of systemic infection with Bartonella in immunocompetent patients – some quite severe.

Researchers need to cease and desist from stating prevalence when testing for all tick-borne infections is abysmal – missing thousands of infected patients.  Since these patients are not being diagnosed, they aren’t counted – which means nobody has a clue on how many are infected.  Researchers can state there are limited recorded cases in the literature, but that is a far cry from reality.  They need to refrain from diminishing this any longer.  It’s almost becoming humorous – if it wasn’t so devastating.

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