A Case of Granulomatous Hepatitis due to Bartonella henselae Infection

Abstract

Purpose:Bartonella henselae (B. henselae) is a rare cause of granulomatous hepatitis. The diagnosis of hepatic bartonellosis may often be difficult to establish due to its fastidious nature, lack of viable species on special stains, and nonspecific findings on histopathology. Once the diagnosis has been established little is known of the optimal treatment. We present a case of hepatic bartonellosis in an immunocompetent woman who presented with right upper quadrant pain and a five centimeter right hepatic lobe mass on CT scan (Figure 1). The patient underwent a right hepatic lobectomy. The surgical pathology revealed florid necrotizing granulomatous hepatitis favoring an infectious etiology (Figure 2). However, despite extensive histological and serological evaluation a definitive diagnosis was not established. Thirteen months later the diagnosis of hepatic bartonellosis was established on the basis of PCR of the surgically removed liver tissue. Interestingly, despite three separate courses of antibiotic therapy, she had evidence of chronic infection on specific enrichment culture of venous blood and histological features of persistent granulomas. Our case illustrates the challenges of establishing the diagnosis of B. henselae-induced granulomatous hepatitis. The optimal treatment of this infection remains to be defined, and careful post-treatment follow-up is recommended.Figure: Abdominal CT image demonstrating a large mass lesion in the right hepatic lobe.Figure: The right partial hepatectomy shows florid necrotizing granulomatous inflammation forming a pseudotumorous mass (Fig. 2, hematoxylin and eosin 100x).