PELOISIS HEPATIS DUE TO : A Hemato-Hepato-Renal SyndromeBARTONELLA HENSELAE: A Hemato-Hepato-Renal Syndrome IN TRANSPLANTATION: A Hemato-Hepato-Renal Syndrome

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Abstract

Background.

Bacillary peliosis hepatis is an uncommon but well recognized disease due to disseminatedBartonella infections occurring predominantly in immunocompromised individuals infected with human immunodeficiency virus, type 1. A similar condition in the absence ofBartonella infection when described in organ transplant patients was felt to be secondary to azathioprine and/or cyclosporine.

Methods.

Herein, we report the first case of bacillary peliosis hepatis due to systemicBartonella 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 bothB henselae andquintana DNA in patient's peripheral blood and liver tissue, were used. Indirect immunofluorescence assay forBartonella serology was performed on peripheral blood.

Results.

Histopathology of the liver biopsy demonstrated peliosis hepatis. Indirect immunofluorescence assay forBartonella serology was positive, andB 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.

Conclusions.

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 systemicBartonella infection, e.g., exposure to cats,Bartonella serology, andBartonella DNA by PCR. A reduction in immunosuppression and prolonged therapy with antibiotics such as erythromycin will often result in early recovery.

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