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Case Reports in Nephrology
Volume 2018, Article ID 9607582, 4 pages
https://doi.org/10.1155/2018/9607582
Case Report

Bartonella Endocarditis Mimicking Crescentic Glomerulonephritis with PR3-ANCA Positivity

1Department of Internal Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
2Department of Pathology, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA

Correspondence should be addressed to Joseph Vercellone; gro.tnomuaeb@enollecrev.hpesoj

Received 14 May 2018; Revised 25 July 2018; Accepted 5 August 2018; Published 19 August 2018

Academic Editor: Kouichi Hirayama

Copyright © 2018 Joseph Vercellone et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bartonella henselae is a fastidious organism that causes cat scratch disease, commonly associated with fever and lymphadenopathy but, in rare instances, also results in culture-negative infectious endocarditis. We describe a patient who presented with flank pain, splenic infarct, and acute kidney injury with an active urinary sediment, initially suspicious for vasculitis, which was subsequently diagnosed as B. henselae endocarditis. Bartonella endocarditis may present with a crescentic glomerulonephritis (GN) and elevated PR3-ANCA antibody titers, mimicking ANCA-associated GN, with 54 cases reported in the literature. Unique to our case in this series is a positive PR3-ANCA antibody despite a negative IIF-ANCA. Thus, the presentation of Bartonella can mimic ANCA-associated GN, and renal biopsy showing immune complex deposition is critical for diagnosis and appropriate treatment.