Poudel Atul, Lew Judy, Slayton William, Dharnidharka Vikas R
Pediatr Transplant. 2014 May;18(3):E83-7. doi: 10.1111/petr.12235.
Bartonella henselae (Bh) is the cause of cat-scratch fever. When infection is symptomatic, it typically presents with singular lymphadenitis and fever. Less commonly, the infection can become disseminated and cause endocarditis, osteomyelitis, and micro-abscesses in multiple sites including liver, spleen, eyes, and brain, especially in immunocompromised patients. Hemophagocytic lymphohistiocytosis (Hlh) is a rare and severe multisystem disorder that may be triggered by infections. In one prior case, Bh, like other infections, has induced Hlh, an immune-mediated disease that can be characterized by septic-like presentation with persistent fevers, hepatosplenomegaly, and pancytopenia. In an immunocompromised transplant recipient, the onset of Hlh can be difficult to discern from a severe presentation of Bh. We report a case of criteria-proven secondary Hlh occurring after Bh infection in an 11-yr-old girl who was 13 months post-renal transplant. The patient developed multi-organ failure, and her severe clinical presentation required a thorough evaluation for infectious and non-infectious possibilities including post-transplant lymphoproliferative disorder and rejection. Early recognition of Hlh allowed for better directed therapies, leading to recovery of the patient and resolution of both Bh and Hlh.
亨氏巴尔通体（Bh）是猫抓热的病原体。当感染出现症状时，通常表现为单一淋巴结炎和发热。较少见的情况下，感染会扩散并导致心内膜炎、骨髓炎以及包括肝脏、脾脏、眼睛和大脑在内的多个部位出现微脓肿，尤其是在免疫功能低下的患者中。噬血细胞性淋巴组织细胞增生症（Hlh）是一种罕见且严重的多系统疾病，可能由感染引发。在之前的一个病例中，Bh与其他感染一样，诱发了Hlh，这是一种免疫介导的疾病，其特征可能为类似败血症的表现，伴有持续发热、肝脾肿大和全血细胞减少。在免疫功能低下的移植受者中，Hlh的发作可能难以与Bh的严重表现相区分。我们报告一例经标准证实的继发性Hlh病例，该病例发生在一名11岁女童身上，她在肾移植后13个月感染了Bh。患者出现多器官功能衰竭，其严重的临床表现需要对包括移植后淋巴细胞增生性疾病和排斥反应在内的感染性和非感染性可能性进行全面评估。对Hlh的早期识别使得治疗更具针对性，从而使患者康复，Bh和Hlh均得到治愈。
