Rapid Diagnosis of Bartonella-Induced Hemophagocytic Lymphohistiocytosis Using Next-Generation Sequencing of Plasma

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is characterized by uncontrolled activation of macrophages and phagocytosis of hematopoietic cells. Recognition and treatment are often delayed in infectious triggers of HLH because of lack of rapid and reliable diagnostic modalities, as well as the need for invasive tissue sampling. We report a rare case of Bartonella-induced HLH in a kidney transplant patient who presented with fever of unknown origin. The diagnosis was expedited with next-generation sequencing of microbial cell-free DNA. We also describe the successful treatment outcome with antibiotics alone and the promising utility of this newer diagnostic method.