Peloisis hepatis due to Bartonella henselae in transplantation: a hemato-hepato-renal syndrome.

Abstract

BACKGROUND:

Bacillary peliosis hepatis is an uncommon but well recognized disease due to disseminated Bartonella infections occurring predominantly in immunocompromised individuals infected with human immunodeficiency virus, type 1. A similar condition in the absence of Bartonella infection when described in organ transplant patients was felt to be secondary to azathioprine and/or cyclosporine.

METHODS:

Herein, we report the first case of bacillary peliosis hepatis due to systemic Bartonella henselae infection in a patient after kidney transplant. The patient presented with severe anemia, persistent thrombocytopenia, and hepato-renal syndrome. DNA-based polymerase chain reactions (PCR), which allowed direct detection of both B henselae and quintana DNA in patient's peripheral blood and liver tissue, were used. Indirect immunofluorescence assay for Bartonella serology was performed on peripheral blood.

RESULTS:

Histopathology of the liver biopsy demonstrated peliosis hepatis. Indirect immunofluorescence assay for Bartonella serology was positive, and B henselae DNA was identified by PCR in the peripheral blood and liver tissue. Treatment with a 3-month course of oral erythromycin resulted in an excellent clinical response.

CONCLUSIONS:

The present case suggests that although various anti-rejection therapies and opportunistic infections are associated with hepatic and renal dysfunction along with bone marrow suppression, the diagnostic evaluation in this situation should include liver biopsy and a careful search for evidence of systemic Bartonella infection, e.g., exposure to cats, Bartonella serology, and Bartonella DNA by PCR. A reduction in immunosuppression and prolonged therapy with antibiotics such as erythromycin will often result in early recovery.

• Authors: N Ahsan, M J Holman, T R Riley, C S Abendroth, E G Langhoff, H C Yang
• Journal: Transplantation (Transplantation) Vol. 65 Issue 7 Pg. 1000-3 (Apr 15 1998) ISSN: 0041-1337 [Print] United States
• PMID: 9565109 (Publication Type: Case Reports, Journal Article)

Chemical References

• Immunosuppressive Agents
• Cyclosporine
• Azathioprine

Topics

• Adult
• Angiomatosis, Bacillary (etiology, microbiology)
• Animals
• Azathioprine (adverse effects, therapeutic use)
• Bartonella henselae
• Cats
• Cyclosporine (adverse effects, therapeutic use)
• Humans
• Immunosuppressive Agents (adverse effects, therapeutic use)
• Kidney Transplantation (adverse effects)
• Male
• Opportunistic Infections (etiology, microbiology)
• Peliosis Hepatis (etiology, microbiology)