From (Cat) Scratch: A Unique Presentation of CNS Bartonella Infection (P2-10.003)

Abstract

<h3>Objective:</h3> NA <h3>Background:</h3> Central Nervous System (CNS) Bartonella infection is rare. Diagnosis is usually performed with serology and confirmed with polymerase chain reaction (PCR). We describe a unique case of disseminated necrotizing brain abscess in an immunocompromised patient caused by Bartonella. <h3>Design/Methods:</h3> A 28-year-old woman with medical history of Systemic Lupus Erythematosus (SLE) on chronic immunosuppression presented with four months of progressive, bilateral, painless vision loss. Two months before presenting to ED, her ophthalmologist increased her prednisone regimen to 80 mg daily due to concern for lupus retinitis. On admission, her ophthalmologic exam was pertinent for decreased visual acuity (20/50 in the right eye and 20/400 in the left eye), chorio-retinal inflammatory lesions and macular edema. MRI of the brain revealed numerous contrast-enhancing lesions throughout the brainstem, cerebral and cerebellar hemispheres. She was started on empiric therapy with ceftriaxone, ganciclovir, voriconazole, pyrimethamine, and sulfadiazine. Infectious etiologies, including HSV, EBV, HIV, mycobacteria, Histoplasma, Blastomyces, Cryptococcus, Toxoplasma were ruled out. CSF showed 1 WBC, 35 Protein, 76 Glucose, flow cytometry and cytology were negative for CNS lymphoma. She was tested for Bartonella henslae and quintana her IgM was negative; IgG was 1:64 (equivocal) and 1:256 (positive), respectively. Due to the lack of clinical improvement, the patient underwent biopsy of the brain lesions with PCR confirming Bartonella infection. She was started on doxycycline and rifampin and discharged home. Brain MRI at 5 weeks post-discharge showed decreased number and size of lesions. <h3>Results:</h3> NA <h3>Conclusions:</h3> We emphasize the consideration of CNS Bartonella infection as an etiology of multiple brain lesions in immunocompromised patients. We encourage evaluation for Bartonella infection if standard infectious workup is negative and there is no improvement with empiric treatment. Prompt diagnosis is important as treatment can improve morbidity and mortality. <b>Disclosure:</b> Dr. Rodriguez has nothing to disclose. Ms. Fedorova has nothing to disclose. Dr. Rukmangadachar has nothing to disclose.