Bartonella Endocarditis and Pauci-Immune Glomerulonephritis

Abstract

Among culture-negative endocarditis in the United States, Bartonella species are the most common cause, with Bartonella henselae and Bartonella quintana comprising the majority of cases. Kidney manifestations, particularly glomerulonephritis, are common sequelae of infectious endocarditis, with nearly half of all Bartonella patients demonstrating renal involvement. Although a pauci-immune pattern is a frequent finding in infectious endocarditis–associated glomerulonephritis, it is rarely reported in Bartonella endocarditis. Anti–neutrophil cytoplasmic antibody (ANCA) positivity can be seen with many pathogens causing endocarditis and has been previously reported with Bartonella species. In addition, ANCA-associated vasculitis can also present with renal and cardiac involvement, including noninfectious valvular vegetations and pauci-immune glomerulonephritis. Given the overlap in their clinical presentation, it is difficult to differentiate between Bartonella endocarditis and ANCA-associated vasculitis but imperative to do so to guide management decisions. We present a case of ANCA-positive Bartonella endocarditis with associated pauci-immune glomerulonephritis that was successfully treated with medical management alone.

Bartonella endocarditis with glomerulonephritis in a patient with complete transposition of the great arteries

“…8 Though IE is associated with hypocomplementic glomerulonephritis, as was seen in this case, glomerulonephritis as a complication of B. henselae endocarditis is rare, with few reported cases. [6][7][8] Multiple studies report that nearly 60% of patients with Bartonella spp. endocarditis have positive antineutrophil cytoplasmic antibody, as was seen in our patient, and some cases may imitate other systemic diseases such as granulomatosis with polyangiitis.…”

“…IE with glomerulonephritis have loop and mesangial deposits of IgM and IgG complexes. 6 Although the exact antibiotic regimens for treatment of Bartonella endocarditis have not been universally agreed upon, the antibiotic regimen consisting of ceftriaxone (6 weeks) plus gentamicin (2 weeks) with/without doxycycline (6 weeks) has been recommended for treatment of suspected Bartonella endocarditis in patients with a prosthetic valve (late, >1 year). The suggested treatment of documented Bartonella endocarditis (culture positive) in patients with a prosthetic valve (late, >1 year) includes doxycycline (6 weeks) and gentamicin (2 weeks).…”

“…endocarditis have positive antineutrophil cytoplasmic antibody, as was seen in our patient, and some cases may imitate other systemic diseases such as granulomatosis with polyangiitis. 5,6 Renal biopsies in these patients may reveal necrotic crescentic disease or diffuse proliferative glomerular disease. 6 Most cases of Bartonella spp.…”

“…5,6 Renal biopsies in these patients may reveal necrotic crescentic disease or diffuse proliferative glomerular disease. 6 Most cases of Bartonella spp. IE with glomerulonephritis have loop and mesangial deposits of IgM and IgG complexes.…”

Bartonella endocarditis in a child with tetralogy of Fallot complicated by PR3‐ANCA positive serology, autoimmune hemolytic anemia, and acute kidney injury

“…In one case, B. henselae was confused with a granulomatosis with polyangiitis (GPA) due to elevated c‐ANCA and anti‐PR3 antibody in a 28‐year‐old with endocarditis of a bicuspid aortic valve 1. Further, this organism has been identified as the causative agent in a growing number of cases of PR3‐ANCA positive subacute bacterial endocarditis (SBE) with accompanying glomerulonephritis 2, 3, 4, 5. Although hematologic manifestations are rare, generalized Bartonella infection has induced an autoimmune hemolytic anemia in at least one case 6.…”