Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, 350 W. 11th street, Indianapolis, IN, 46202, USA.
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
BMC Nephrol. 2022 May 12;23(1):181. doi: 10.1186/s12882-022-02811-w.
Bartonella endocarditis is often a diagnostic challenge due to its variable clinical manifestations, especially when it is first presented with involvement of organs other than skin and lymph nodes, such as the kidney.
This was a 13-year-old girl presenting with fever, chest and abdominal pain, acute kidney injury, nephrotic-range proteinuria and low complement levels. Her kidney biopsy showed diffuse crescentic proliferative glomerulonephritis with a full-house pattern of immune complex deposition shown by immunofluorescence, which was initially considered consistent with systemic lupus erythematous-associated glomerulonephritis (lupus nephritis). After extensive workup, Bartonella endocarditis was diagnosed. Antibiotic treatment and valvular replacement surgery were undertaken with subsequent return of kidney function to normal range.
This case demonstrates the importance of considering the full clinical picture when interpreting clinical, laboratory and biopsy findings, because the treatment strategy for infective endocarditis versus lupus nephritis is drastically different.
由于其多变的临床表现，特别是当它首次表现为皮肤和淋巴结以外的器官受累时，如肾脏，Bartonella 心内膜炎常常是一个诊断挑战。
这是一名 13 岁女孩，表现为发热、胸痛和腹痛、急性肾损伤、肾病范围蛋白尿和低补体水平。她的肾脏活检显示弥漫性新月体性增生性肾小球肾炎，免疫荧光显示满堂免疫复合物沉积，最初考虑符合系统性红斑狼疮相关肾小球肾炎（狼疮性肾炎）。经过广泛的检查，诊断为 Bartonella 心内膜炎。进行了抗生素治疗和瓣膜置换手术，随后肾功能恢复正常范围。
本例表明，在解释临床、实验室和活检结果时，考虑全面的临床表现非常重要，因为感染性心内膜炎与狼疮性肾炎的治疗策略有很大的不同。
