SHM Converge Scientific Abstract ePoster Gallery-Bartonella Henselae Infection of Icd Lead Presenting as Rapidly Progressive Crescentic Glomerulonephritis

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This case report describes a 61-year-old woman with cirrhosis and heart failure with an implanted ICD who presented with acute kidney injury and intermittent fevers. Although she had no cat scratch history, she had cat flea exposure. Her creatinine rose from a baseline of 1.8 to 6.6 mg/dL. Kidney biopsy showed rapidly progressive crescentic glomerulonephritis with C3 deposits. She also developed a rash, and skin biopsy revealed intraepidermal vesicular dermatitis with dense neutrophilic inflammation.<br /><br />Further evaluation identified a 1.6 x 1.0 cm vegetation on the right ventricular ICD lead by transthoracic echocardiography. Blood cultures were negative, but Bartonella henselae serologies were strongly positive, supporting culture-negative device-related endocarditis. The case emphasizes that Bartonella infection can present atypically, with immune-complex mediated glomerulonephritis and negative cultures.<br /><br />Treatment included doxycycline 100 mg every 12 hours planned for 12 weeks and rifampin 300 mg every 12 hours planned for 6 weeks, along with prednisone starting at 40 mg daily and tapering by 10 mg weekly for the glomerulonephritis. After one month, her skin lesions improved significantly and creatinine decreased to 2.98 mg/dL. She then underwent successful removal of the infected ICD.<br /><br />The report highlights the importance of considering Bartonella henselae in patients with unexplained rapidly progressive glomerulonephritis, especially when endocarditis or implanted cardiac hardware is present. Early recognition is critical because timely antimicrobial therapy, combined when needed with immunosuppression, may improve both infection control and renal outcomes.

Asset Subtitle

Amina Islam

Meta Tag

Author List Alyssa Bren, Amina Islam, Andrew Alter, Angel Zhang, Danielle Cicka, Kelli King-Morris, Madeleine Yancy, Vinay Penna

Category Clinical Vignettes

Concept Bartonella henselae

Concept Culture-negative endocarditis

Concept Infection-related glomerulonephritis

Concept Rapidly Progressive Glomerulonephritis

Concept Crescentic glomerulonephritis

Distinguished Non-Finalist

Presenter Organization Washington University in St. Louis School of Medicine

Presenting Author Amina Islam

Track Adult

Keywords

Bartonella henselae

culture-negative endocarditis

implantable cardioverter defibrillator

rapidly progressive glomerulonephritis

crescentic glomerulonephritis

immune-complex nephritis

acute kidney injury

cat flea exposure

doxycycline

rifampin

Bartonella henselae

Culture-negative endocarditis

Infection-related glomerulonephritis

Rapidly Progressive Glomerulonephritis

Crescentic glomerulonephritis