Bartonella henselae infection inducing hemophagocytic lymphohistiocytosis in a kidney transplant recipient

Atul Poudel, Judy Lew, William Slayton, Vikas R. Dharnidharka

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Bartonella henselae (Bh) is the cause of cat-scratch fever. When infection is symptomatic, it typically presents with singular lymphadenitis and fever. Less commonly, the infection can become disseminated and cause endocarditis, osteomyelitis, and micro-abscesses in multiple sites including liver, spleen, eyes, and brain, especially in immunocompromised patients. Hemophagocytic lymphohistiocytosis (Hlh) is a rare and severe multisystem disorder that may be triggered by infections. In one prior case, Bh, like other infections, has induced Hlh, an immune-mediated disease that can be characterized by septic-like presentation with persistent fevers, hepatosplenomegaly, and pancytopenia. In an immunocompromised transplant recipient, the onset of Hlh can be difficult to discern from a severe presentation of Bh. We report a case of criteria-proven secondary Hlh occurring after Bh infection in an 11-yr-old girl who was 13 months post-renal transplant. The patient developed multi-organ failure, and her severe clinical presentation required a thorough evaluation for infectious and non-infectious possibilities including post-transplant lymphoproliferative disorder and rejection. Early recognition of Hlh allowed for better directed therapies, leading to recovery of the patient and resolution of both Bh and Hlh.

Original languageEnglish
Pages (from-to)E83-E87
JournalPediatric transplantation
Volume18
Issue number3
DOIs
StatePublished - Jan 1 2014

Keywords

  • Bartonella henselae
  • hemophagocytic lymphohistiocytosis
  • renal transplant

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