SHM Converge Scientific Abstract ePoster Gallery-Systemic Bartonella Infection Presenting as Culture-Negative Endocarditis With Immune-Complex Crescentic Glomerulonephritis and Cofounding Hepatitis C-Associated Cryoglubulinemia

Systemic Bartonella Infection Presenting as Culture-Negative Endocarditis With Immune-Complex Crescentic Glomerulonephritis and Cofounding Hepatitis C-Associated Cryoglubulinemia

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This case describes a 42-year-old man with untreated chronic hepatitis C and remote IV drug use who presented with six months of fatigue, weight loss, fevers, petechiae, abdominal distension, dyspnea, pancytopenia, acute kidney injury, hematuria, proteinuria, massive splenomegaly, and ascites. He had a prior history of culture-negative endocarditis with porcine aortic valve replacement.<br /><br />Although transthoracic and transesophageal echocardiography showed no vegetations, serology and PCR were strongly positive for Bartonella henselae and Bartonella quintana. With IgG titers of 1:1024 and positive PCR, he met 2023 Duke–ISCVID major criteria for definite Bartonella culture-negative endocarditis. Kidney biopsy showed diffuse crescentic glomerulonephritis with C3-dominant immune-complex deposition, consistent with infection-associated glomerulonephritis.<br /><br />He was treated with doxycycline, rifampin, and corticosteroids, but symptoms worsened after he stopped therapy early and improved after treatment was restarted.<br /><br />The report emphasizes that Bartonella endocarditis can be present even when echocardiography is negative, especially in prosthetic valve disease, and that FDG-PET/CT may help in difficult cases. It also highlights that Bartonella infection commonly causes immune-complex glomerulonephritis, which can mimic autoimmune vasculitis. In this patient, hepatitis C–associated cryoglobulinemia complicated the picture, but biopsy findings and response to antibiotics supported Bartonella-driven disease.<br /><br />Overall, the case underscores the importance of early Bartonella serology and PCR testing in culture-negative endocarditis, particularly when renal disease or immune-complex phenomena are present, and cautions against escalating immunosuppression before infection is excluded.

Asset Subtitle

Maria F. Rosero Basurto

Meta Tag

Author List Anca E. Andrei, David Kornblum, Israel Rosero Basurto, Maria F. Rosero Basurto

Category Clinical Vignettes

Concept Bartonella henselae

Concept Bartonella quintana

Concept Culture-negative endocarditis

Concept Immune-complex crescentic glomerulonephritis

Concept DukeISCVID diagnostic criteria

Distinguished Non-Finalist

Presenter Organization Pioneer Medical Group

Presenting Author Maria F. Rosero Basurto

Track Adult

Keywords

Bartonella endocarditis

culture-negative endocarditis

Bartonella henselae

Bartonella quintana

prosthetic valve

immune-complex glomerulonephritis

crescentic glomerulonephritis

chronic hepatitis C

PCR serology

FDG-PET/CT

Bartonella henselae

Bartonella quintana

Culture-negative endocarditis

Immune-complex crescentic glomerulonephritis

DukeISCVID diagnostic criteria