Bartonella-Associated Endocarditis with Severe Active Crescentic Glomerulonephritis and Acute Renal Failure
Table 2
Key teaching points.
(1) Bartonella henselae should be checked in cases of culture-negative endocarditis who present with renal failure. Bartonella avoids detection by routine blood cultures. Detection requires specific growth medium and extended incubation periods.
(2) PR-3 ANCA may be positive in Bartonella henselae endocarditis with crescentic glomerulonephritis. A complete infectious workup should be done before immunosuppression is initiated in patients with crescentic glomerulonephritis.
(3) In patients with infective endocarditis, the predominant pattern of glomerular injury is crescentic glomerulonephritis.
(4) Since there are no bactericidal antibiotics available to treat Bartonella henselae, the antigen may persist even after antibiotic administration, potentially allowing a continued immune response with immune complex formation for days to weeks after antibiotic therapy initiation.
