Ouellette Christopher P, Joshi Sarita, Texter Karen, Jaggi Preeti
From the *Division of Infectious Diseases and Immunology, Department of Pediatrics, †Division of Hematology and Oncology, Department of Pediatrics, and ‡Division of Cardiology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
Pediatr Infect Dis J. 2017 May;36(5):516-520. doi: 10.1097/INF.0000000000001510.
Two children with congenital heart disease status post surgical correction presented with prolonged constitutional symptoms, hepatosplenomegaly and pancytopenia. Concern for malignancy prompted bone marrow biopsies that were without evidence thereof. In case 1, echocardiography identified a multilobulated vegetation on the conduit valve. In case 2, transthoracic, transesophageal and intracardiac echocardiography were performed and were without evidence of cardiac vegetations; however, pulmonic emboli raised concern for infective endocarditis. Both patients underwent surgical resection of the infected material and had histopathologic evidence of infective endocarditis. Further diagnostics identified elevated cytoplasmic antineutrophil cytoplasmic antibodies and antiproteinase 3 antibodies in addition to acute kidney injury with crescentic glomerulonephritis on renal biopsy. Serologic evidence of infection with Bartonella henselae was observed in both patients. These 2 cases highlight the potential multiorgan involvement that may confound the diagnosis of culture-negative infective endocarditis caused by B. henselae.
两名先天性心脏病术后矫正患儿出现长期全身症状、肝脾肿大和全血细胞减少。因怀疑恶性肿瘤而行骨髓活检，但未发现相关证据。病例1中，超声心动图在导管瓣膜上发现一个多叶状赘生物。病例2中，进行了经胸、经食管和心内超声心动图检查，未发现心脏赘生物；然而，肺栓塞引发了对感染性心内膜炎的担忧。两名患者均接受了感染物质的手术切除，组织病理学证据显示为感染性心内膜炎。进一步诊断发现，除了肾活检显示急性肾损伤伴新月体性肾小球肾炎外，还发现细胞质抗中性粒细胞胞浆抗体和抗蛋白酶3抗体升高。两名患者均有感染亨氏巴尔通体的血清学证据。这两个病例突出了可能混淆由亨氏巴尔通体引起的血培养阴性感染性心内膜炎诊断的潜在多器官受累情况。
