Peloisis hepatis due to Bartonella henselae in transplantation

A hemato-hepato-renal syndrome

Nasimul Ahsan, Michael J. Holman, Thomas Riley III, Catherine Abendroth, Erik G. Langhoff, Harold C. Yang

Research output: Contribution to journalArticle

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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 pedants 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 FCR. A reduction in immunosuppression and prolonged therapy with antibiotics such as erythromycin will often result in early recovery.

Original languageEnglish (US)
Pages (from-to)1000-1003
Number of pages4
JournalTransplantation
Volume65
Issue number7
DOIs
StatePublished - Apr 15 1998

Fingerprint

Bartonella henselae
Bartonella Infections
Bartonella
Peliosis Hepatis
Transplantation
Kidney
Serology
Liver
Erythromycin
Indirect Fluorescent Antibody Technique
Immunosuppression
DNA
Transplants
Biopsy
Polymerase Chain Reaction
Opportunistic Infections
Azathioprine
DNA-Directed DNA Polymerase
Thrombocytopenia
Cyclosporine

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Ahsan, Nasimul ; Holman, Michael J. ; Riley III, Thomas ; Abendroth, Catherine ; Langhoff, Erik G. ; Yang, Harold C. / Peloisis hepatis due to Bartonella henselae in transplantation : A hemato-hepato-renal syndrome. In: Transplantation. 1998 ; Vol. 65, No. 7. pp. 1000-1003.
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Peloisis hepatis due to Bartonella henselae in transplantation : A hemato-hepato-renal syndrome. / Ahsan, Nasimul; Holman, Michael J.; Riley III, Thomas; Abendroth, Catherine; Langhoff, Erik G.; Yang, Harold C.

In: Transplantation, Vol. 65, No. 7, 15.04.1998, p. 1000-1003.

Research output: Contribution to journalArticle

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T1 - Peloisis hepatis due to Bartonella henselae in transplantation

T2 - A hemato-hepato-renal syndrome

AU - Ahsan, Nasimul

AU - Holman, Michael J.

AU - Riley III, Thomas

AU - Abendroth, Catherine

AU - Langhoff, Erik G.

AU - Yang, Harold C.

PY - 1998/4/15

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N2 - 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 pedants 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 FCR. A reduction in immunosuppression and prolonged therapy with antibiotics such as erythromycin will often result in early recovery.

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