Bartonella-Associated Endocarditis with Severe Active Crescentic Glomerulonephritis and Acute Renal Failure

Ramanath Dukkipati,Cynthia C Nast,Benjamin Lawson,Anuja Shah,Kouichi Hirayama

doi:10.1155/2021/9951264

Abstract

We report a case of severe acute kidney failure due to crescentic glomerulonephritis who presented initially with culture-negative endocarditis with vegetations on the aortic valve. Anti-nuclear and anti-phospholipid antibodies were positive with initially negative anti-neutrophil cytoplasmic antibodies (ANCAs). Kidney biopsy revealed severe acute crescentic glomerulonephritis with mesangial immune complex deposition. PR3-ANCA subsequently become positive, and the patient developed worsening kidney failure requiring hemodialysis. This case illustrates that Bartonella can present as culture-negative endocarditis with severe crescentic glomerulonephritis with positive PR-3 ANCAs and can mimic ANCA-associated crescentic glomerulonephritis.

Highlights

Infective endocarditis- (IE-) associated glomerulonephritis (GN) has been reported to present commonly with acute kidney injury (AKI) and tricuspid valve infection due to Staphylococcus
Glomerulonephritis that is associated with infection is diverse, but the most common pattern of glomerular injury in IE-associated glomerulonephritis is crescentic and necrotizing glomerulonephritis [1, 2]. ere are only few reported cases of Bartonella henselae-associated IE presenting with severe renal failure due to necrotizing and crescentic glomerulonephritis [3, 4]
We report a case of a 70-year-old female who presented with severe renal failure due to acute crescentic glomerulonephritis and Bartonella-associated vegetation and insufficiency of the aortic valve

Summary

Background

Infective endocarditis- (IE-) associated glomerulonephritis (GN) has been reported to present commonly with acute kidney injury (AKI) and tricuspid valve infection due to Staphylococcus. Ere are only few reported cases of Bartonella henselae-associated IE presenting with severe renal failure due to necrotizing and crescentic glomerulonephritis [3, 4]. We report a case of a 70-year-old female who presented with severe renal failure due to acute crescentic glomerulonephritis and Bartonella-associated vegetation and insufficiency of the aortic valve. At presentation, she tested negative for PR-3 ANCA and MPO-ANCA but later during the course of hospitalization became positive for PR-3. She became dialysis dependent and was treated with rifampin and doxycycline

Case Report

Findings

Discussion