Description of five cases of bartonellosis with fever and atypical clinical presentations in kidney transplant recipients : thrombotic microangiopathies, recurrent haemophagocytosis and immune reconstitution syndrome after treatment. The diagnosis, the pathological lesions, and treatments are described. Bartonellosis must be researched in solid organ transplant recipients with fever of undetermined origin.

Prenatal diagnosis is fundamental in the therapeutic approach to this rare lesion but remains difficult because the findings are non specific and the generally late development of the tumor.

Lymph node involvement in cat scratch disease is characterized by a granulomatous lymphadenitis with micro-abscesses. Recently, it has been shown that the possible aetiological agent is a micro-organism which stains with some silver stains. In this study 60 lymph nodes were studied from 60 patients, using a modified Dieterlé's stain. In 40 cases (66%) rod-shaped bacilli with rounded extremities were observed. They were negative both with the Gram and Ziehl-Neelsen stains. Since such micro-organisms were demonstrated in the majority of the nodes examined, it can be concluded that silver stains are appropriate for the diagnosis of this condition.

Background Lyme borreliosis is the most prevalent arthropod-borne infection in the Northern Hemisphere. In Europe, Borrelia afzelii is predominantly involved in cutaneous manifestations, Borrelia garinii and Borrelia bavariensis in neurological manifestations, and Borrelia burgdorferi sensu stricto in articular ones. Liver impairement is not classical in Lyme borreliosis. Diagnosis is currently mainly based on serological testing, and is challenging in immunocompromised patients. Case presentation We report the first case of B. garinii infection revealed by liver involvement in an immunocompromised man. A 73-year-old man with marginal zone lymphoma, treated with bendamustine and rituximab, developed intermittent fever and inflammatory syndrome. Microbial investigations were all negative and FDG-PET showed complete remission of the lymphoma. Three months later, liver biopsy was performed and histology revealed spirochetes-like bacteria. Microbial diagnosis was performed by 16S rDNA sequencing, flagellin (flaB) gene sequencing and multi-locus sequence typing and identified B. garinii. The patient recovered successfully after a three weeks course of antibiotics. Diagnosis was challenging because Borrelia hepatic involvement is unusual and no erythema migrans nor tick bite were notified. Conclusion This case highlights that unexplained fever and inflammatory syndrome in immunocompromised patients warrants specific investigations to identify bacteria such as spirochetes.

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