A Case of Glomerulonephritis Caused by Bartonella spp. Infective Endocarditis: The Difficulty and Importance of Differentiation from Anti-neutrophil Cytoplasmic Antibody-related Rapidly Progressive Glomerulonephritis

Published Date
Journal
Internal Medicine
Citation
10.2169/internalmedicine.5608-20
DOI
10.2169/internalmedicine.5608-20
Authors
Yoshifuji A
Hibino Y
Komatsu M
Yasuda S
Hosoya K
Kobayashi E
Baba Y
Hirose S
Hashiguchi A
Kanno Y
Ryuzaki M
Abstract

A 65-year-old man with valvular disorder presented to his physician because of widespread purpura in both lower extremities. Blood tests showed elevated serum creatinine levels and proteinase 3-anti-neutrophil cytoplasmic antibody (ANCA) with hematuria, suggesting ANCA-related rapidly progressive glomerulonephritis (RPGN). Although multiple blood cultures were negative, transthoracic echocardiography revealed warts in the valves, and a renal biopsy also showed findings of glomerular infiltration by mononuclear leukocytes and C3 deposition in the glomeruli, suggesting infection-related glomerulonephritis. Later, Bartonella antibody turned positive. Antimicrobial treatment improved the purpura and renal function without any recurrence. ANCA-positive RPGN requires the exclusion of infective endocarditis, especially that induced by Bartonella spp.

Keywords: ANCA; Bartonella; infective endocarditis; rapidly progressive glomerulonephritis.