Bartonella henselae infection-mediated shunt nephritis.

Serum anti-neutrophil cytoplasmic antibody (ANCA) positivity with membranoproliferative pattern on renal biopsy can be due to ANCA-associated vasculitis as well as chronic indolent infections. We present the case of an adolescent boy with congenital heart disease and history of cardiac surgery who presented with severe acute kidney injury requiring hemodialysis. Renal biopsy showed membranoproliferative glomerulonephritis with full-house immunofluorescence pattern. Low serum complements, PR3 ANCA positivity and elevated

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© Dustri-Verlag Dr. K. Feistle.

Déclaration de conflit d'intérêts

Authors have no conflict of interest to disclose. Figure 1.Light microscopy: proliferative glomerulus showing lobulation and neutrophilic infiltrate (arrow showing the neutrophilic infiltrate).Figure 2.Immunofluorescence staining: positive for C1q, C3, IgA, IgG, and IgM antibodies, consistent with “full-house” pattern.Figure 3.Electron microscopy. A: Fusion of podocytes with expansion of mesangial matrix. B: Subendothelial and rare subepithelial deposits with thickened basement membranes. C: Subendothelial deposits. Table 1.Summary of infectious disease and immunology/serology work-up. Infectious disease work-upTestResultInitial blood aerobic and anaerobic culturesNo growthRepeat blood aerobic and anaerobic cultures (3 days later)No growth4th generation HIV testNon-reactivePPD skin testNo indurationQuantiFERON goldNegative for tuberculosisInfectious hepatitis panelNegativeHepatitis IgM antibodyNon-reactiveHepatitis C antibodyNegativeHistoplasma urine antigenNegativeFungal antibody panelNegativeBlastomyces, Coccidioides, Histoplasma antibodiesNegativeCryptococcal antigenNegativeCytomegalovirus quantitative PCRNegativeAdenovirus PCRNegativeCoxiella brunetti IgG antibodyNegativeBartonella henselae IgG antibody> 1 : 1,024Bartonella henselae IgM antibodyNegativeBartonella quintana IgG antibody1 : 256Bartonella quintana IgM antibodyNegativeWhole blood Bartonella PCRB. quintana: not detectedB. henselae: detectedRespiratory bacterial and fungal culturesNegativePneumocystis jirovecciNegativeLegionella pneumonia cultureNo growthImmunological/Serological work-upTestResultC-reactive protein (CRP)0.65 mg/dLComplement C3< 10 mg/dLComplement C4< 7 mg/dLAnti-streptolysin O (ASO) titers< 50 IU/mLAntinuclear antibodyNegativeDouble stranded DNA antibody< 1 IU/mLANCA PR3 antibody21.8 AIANCA myeloperoxidase antibody< 1 AISmith antibodyNegativeRNP antibodyNegativeSSA/SSBNegativeAntiphospholipid antibodiesNegativeDirect antiglobulin test/Direct CoombsNegativeAntiplatelet antibodiesNegative