Ahsan N, Holman M J, Riley T R, Abendroth C S, Langhoff E G, Yang H C
Department of Medicine, The Milton S. Hershey Medical Center, Pennsylvania State University, College of Medicine, Hershey 17033, USA.
Transplantation. 1998 Apr 15;65(7):1000-3. doi: 10.1097/00007890-199804150-00024.
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 patients was felt to be secondary to azathioprine and/or cyclosporine.
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.
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.
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 PCR. A reduction in immunosuppression and prolonged therapy with antibiotics such as erythromycin will often result in early recovery.
肝杆菌性紫癜是一种不常见但已被充分认识的疾病，由播散性巴尔通体感染引起，主要发生在感染1型人类免疫缺陷病毒的免疫功能低下个体中。在器官移植患者中，若不存在巴尔通体感染而出现类似情况，则认为是硫唑嘌呤和/或环孢素所致。
在此，我们报告首例肾移植患者因全身性亨氏巴尔通体感染导致肝杆菌性紫癜的病例。该患者出现严重贫血、持续性血小板减少和肝肾综合征。采用基于DNA的聚合酶链反应（PCR），可直接检测患者外周血和肝组织中的亨氏巴尔通体和五日热巴尔通体DNA。对外周血进行巴尔通体血清学间接免疫荧光检测。
肝活检的组织病理学显示肝紫癜。巴尔通体血清学间接免疫荧光检测呈阳性，PCR在外周血和肝组织中鉴定出亨氏巴尔通体DNA。口服红霉素治疗3个月疗程后临床反应良好。
本病例表明，尽管各种抗排斥治疗和机会性感染与肝肾功能障碍及骨髓抑制有关，但在这种情况下的诊断评估应包括肝活检，并仔细寻找全身性巴尔通体感染的证据，如接触猫、巴尔通体血清学检测以及通过PCR检测巴尔通体DNA。减少免疫抑制并延长使用红霉素等抗生素治疗通常会使患者早日康复。
