Autoimmune haemolytic anaemia triggered by Bartonella henselae infection: a case report

Abstract

Summary. Bartonella henselae is a hitherto unidentified cause of autoimmune haemolytic anaemia. Here we report a case of Coombs-negative autoimmune haemolytic anaemia. The episode was preceded by exposure to a cat and a non-specific infectious syndrome. Concomitant serum titres of B. henselae antibodies were indicative of a recent infection. The case report suggests that B. henselae infection can trigger secondary autoimmune haemolytic anaemia.Keywords: autoimmune haemolytic anaemia, Bartonella henselae.A 60-year-old-man with a history of smoking, recurring gastric ulcers and arteriosclerotic disease, was referred from another hospital because of severe Coombs-negative haemolytic anaemia. He experienced pleuritic right-sided chest pain for 2 weeks, and night sweats for several weeks. A computerized tomography (CT) scan performed at the referring hospital had revealed a limited pleural effusion at the base of the right lung. In the referring hospital he had been administered amoxicillin/clavulanic acid and doxycyclin for 5 d, but otherwise no new drugs had been added to his prescriptions in the preceding weeks.On arrival the patient was pale and tachypneic, with an otherwise unremarkable physical examination. A blood smear revealed spherocytosis and polychromatophilia, but no schistocytes. Absolute and relative reticulocyte count were strongly elevated, with undetectable serum haptoglobin, unconjugated hyperbilirubinaemia, increased serum lactate dehydrogenase (LDH) ( Table I) and free plasma haemoglobin [390 mg/l on d 3 (normal value 0±100 mg/ l)]. Direct and indirect antiglobulin tests were negative, as were cold agglutinins and Donath±Landsteiner antibodies. Examination of a bone marrow aspirate showed a hyperplastic erythropoiesis, without erythrocyte inclusions or haemophagocytosis.Based on a negative medical and negative family history and on exclusion of other known mechanisms that can produce infection-related anaemia or haemolysis, a diagnosis of Coombs-negative autoimmune haemolytic anaemia was made. Antibiotics were discontinued upon admission (d 1), and methylprednisolone was given at 1 g/d for 3d, followed by oral methylprednisolone in tapering doses. Two units of erythrocyte concentrates were given on d 5. In the following weeks control of haemolytic anaemia was rapidly achieved (Table I).Because of recent exposure to a cat at his daughter's home, serology for B. henselae was requested. On d 8 an IgM titre of 1/64 and an Ig G titre of . 1/512 were found. Follow-up on d 68 gave a negative IgM titre and an IgG titre of . 1/512. Serological tests were otherwise negative for Chlamydia, Mycoplasma pneumoniae, cytomegalovirus, Epstein-Barr virus, parvo virus B19, human immunodeficiency virus (HIV), and hepatitis B and C virus. A CT scan during hospital admission failed to show enlarged lymph nodes or hepatosplenomegaly. DISCUSSIONGiven the patient's recent exposure to a cat, the high antibody titres (both IgG and IgM) specific for B. henselae at the time of the haemolytic episode with negative IgM titres ...

Severe Anemia, Panserositis, and Cryptogenic Hepatitis in an HIV Patient Infected withBartonella henselae

“…In addition, B. henselae is a well-recognized cause of prolonged fever of unknown origin, cat-scratch disease, BA, peliosis hepatis, and endocarditis. Infection with B. henselae has also been implicated as a cause of hemolytic anemia, thrombocytopenia, granulomatous hepatitis, and menigoencephalitis [13,[15][16][17][18].…”

Intruders below the Radar: Molecular Pathogenesis of Bartonella spp

“…Importantly, immune-mediated hemolytic anemia has also been reported as a rare complication of infections with modern bartonellae (50,159,424), implying that the bacterial factor(s) or strategy triggering hemophagocytosis may be conserved but somehow masked or more tightly regulated in these species. On the other hand, persistent and asymptomatic bacteremia of B. bacilliformis seems to be relatively frequent in the areas of endemicity (see above), indicating that the devastating hemolysis during Oroya fever may not be a necessary part of the infection strategy of this species.…”

<b><i>Bartonella henselae</i></b> Infection Associated with Autoimmune Thyroiditis in a Child

“…Bartonella infection has been associated with the development of systemic juvenile rheumatoid arthritis in a 4-year-old girl [3], severe Coomb's-negative autoimmune hemolytic anemia in an adult man [2], IgA nephritis in a 13-year-old boy [5], and transverse myelitis in an adolescent and adult [14]. In all these patients, clinical and serological evidence of B. henselae infection was found at the time of diagnosis of autoimmune disease.…”

“…Bartonella infection is also associated with autoimmune conditions, particularly, hemolytic anemia [2], thrombocytopenic purpura, systemic juvenile rheumatoid arthritis [3], vasculitis [4], glomerulonephritis [5], Schonlein-Henoch purpura [6], Guillain-Barrè syndrome [7]. The pathogenesis of autoimmune diseases is multifactorial, including both genetic and environmental factors.…”