Disseminated Bartonella infection with granulomatous hepatitis in a liver transplant recipient

Abstract

Disseminated infection with Bartonella spp with granulomatous hepatitis was diagnosed in a liver transplant recipient presenting with fever of unknown origin. Pathological findings on liver biopsy were atypical, with scant granulomas seen only after a second biopsy. The patient responded promptly to antibiotic therapy. Infections caused by Bartonella spp should be considered in transplant recipients with fever of unknown origin. Copyright 1999 by the American Association for the Study of Liver Diseases Bartonella henselae has been recognized as the etiologic agent of cat-scratch disease and the cause of skin lesions known as bacillary angiomatosis, most commonly described in HIV-positive patients. 1 Also, disseminated disease caused by B henselae may result in necrotizing granulomatous involvement of the liver and other organs. 1,2 Infections caused by Bartonella spp are uncommonly reported in transplant recipients. We report a case of a liver transplant recipient who presented with fever of unknown origin and was found to have infection caused by Bartonella spp with granulomatous hepatitis of the transplant allograft. Case ReportA 44-year-old woman who had undergone an orthotopic liver transplantation for hepatitis C and alcoholic cirrhosis 4 years earlier presented with a 3-week history of fever. Past medical history included diabetes mellitus, hypertension, and splenectomy. She complained of daily fever spikes of 39°C to 40°C, headaches, myalgias, arthralgias, fatigue, and drenching night sweats. She had no abdominal pain or gastrointestinal symptoms. Travel history was unremarkable. She had two cats, aged 1 and 3 years, but did not recall any recent scratches. She had no history of tuberculosis exposure, other animal contact, or ingestion of raw milk or cheese. Her current immunosuppression therapy consisted of prednisone, 5 mg/d, and mycophenolate mofetil, 2 g/d. On physical examination, her temperature was 39.5°C. Her liver was palpable 3 cm below the right margin. The remainder of her examination was normal. Laboratory studies showed a normal leukocyte count; aspartate aminotransferase level, 77 U/L; alanine aminotransferase level, 44 U/L; and alkaline phosphatase level, 317 U/L. Routine blood cultures and a cytomegalovirus antigenemia assay were negative. A computed tomographic (CT) scan of her head and a cerebrospinal fluid analysis both showed normal results. Abdominal and thoracic CT scans showed an enlarged liver with no focal lesions and several mildly enlarged mediastinal and intraabdominal lymph nodes. Toxoplasma serological test results and a tuberculin skin test result were negative.A liver biopsy specimen (stained with hematoxylin and eosin) showed moderate to severe portal and parenchymal cellular infiltrates (plasma cells, lymphocytes, and eosinophils). Routine cultures of the liver tissue were negative, as were mycobacterial, fungal, and viral cultures. A second liver biopsy was performed and showed patchy severe portal and periportal cellular infiltrates and a few clusters of cells with foc...

Disseminated Infection With Bartonella henselae in a Lung Transplant Recipient

“…[7][8][9][10][11][12][13] Interestingly, our patient did not develop fever before antibiotic therapy with clarithromycin and ciprofloxacin was initiated. In most previous reports of solid-organ recipients with CSD, lymphadenopathy was present.…”

Factors associated with the rapid emergence of zoonotic Bartonella infections

“…Histopathologically, cutaneous BA is characterized by a tumorlike growth pattern with proliferation of capillaries having protuberant epitheloid endothelial cells [127,193]. In transplant patients, various clinical manifestations or pathological lesions have been reported, such as pulmonary nodules [34] or sternal abscess [32], disseminated infection with granulomatous hepatitis [112], acute organ rejection [66], bacillary peliosis [2] and bacillary angiomatosis [118]. A case of hemophagocytic syndrome in a transplant patient was recently associated with B. henselae infection [119].…”

Cryptogenic Hepatitis and Bartonellosis

“…Bartonella spp. infection has been reported in liver transplant recipients [9][10][11]. The recipients may have been previously infected or contracted the infection through donor liver [5] or blood transfusion [12].…”