DISASTROUS CONSEQUENCES FROM ADORABLE BUT PERILOUS COMPANIONS: A CASE REPORT AND LITERATURE REVIEW OF BARTONELLA ENDOCARDITIS WITH RAPIDLY PROGRESSIVE GLOMERULONEPHRITIS

7 Feb 2025 12 a.m. 12 a.m.

WCN25-AB-2540, Poster Board= FRI-039

Introduction:

Infective endocarditis is a detrimental illness with a high mortality rate. It occurs mainly in immunocompromised individuals with risk factors such as congenital valvular heart disease, rheumatic heart disease, prosthetic valve, and central venous catheter. To date, there is no reported case of infective endocarditis in immunocompetent individuals without risk factors. The clinical manifestations of infective endocarditis vary greatly from subtle prolonged febrile illness to severe disease with cardiogenic shock due to valve failure. Rarely, a rapidly declining renal function due to endocarditis- or infection-related glomerulonephritis with subtle clinical symptoms triggers the alarm for medical attention in infective endocarditis.

Methods:

A case report of Bartonella endocarditis with infection-related glomerulonephritis with literature review

Results:

We report a case of a cat lover without pre-existing medical conditions who presented with a month of febrile illness with rapidly declining renal function. His physical examination revealed a grade 3 pansystolic murmur over the heart apex region radiating to the axilla. A transthoracic echocardiogram showed good left ventricular function with no regional wall motion abnormalities and a slightly dilated left atrium with an echogenic mass at the tip of posterior mitral valve leaflet which was confirmed by a transesophageal echocardiogram to be a large oscillating mass measuring 2.2 x 1.1 cm causing severe eccentric anteriorly directed mitral regurgitation due to prolapse frail posterior mitral valve leaflet (Figure 1). After thorough investigations, he was diagnosed with Bartonella endocarditis with infection-related glomerulonephritis. However, he succumbed despite adequate antibiotics and valve replacement (Figure 2).

Table 1. Previous case reports on Bartonella endocarditis with infection-related glomerulonephritis.

Author	Year	Age (years) / Sex	Co-morbidities	Clinical Manifestations	Treatment	Outcome
Bookman I et al Canada	2004	53/F	Rheumatic heart disease Congestive heart failure Hypothyroidism Acquired brain injury from motor vehicle accident	Mild heart failure symptoms followed by rapid deterioration of renal function during hospitalization	Intravenous methylprednisolone followed by tapering prednisolone and six weeks of ceftriaxone and doxycycline	Readmission four months later with renal failure and succumbed to death
Bookman I et al Canada	2004	35/M	Post valvulotomy for congenital bicuspid valvular disease with aortic stenosis	Persistent fever and cough followed by rapid deterioration of renal function during hospitalization	High dose prednisolone followed by tapering dose, six weeks of intravenous antibiotics and valve replacement	Discharged well with good renal recovery
Bookman I et al Canada	2004	46/M	History of alcohol and benzodiazepine addiction Peptic ulcer disease Chronic obstructive pulmonary disease	Cough and haemoptysis followed by rapid deterioration of renal function during hospitalization	Temporary haemodialysis, six weeks of intravenous antibiotics and valve replacement	Discharged well with good renal recovery
Khalighi MA et al USA	2014	18/F	Charcot-Marie-Tooth Tetralogy of Fallot with an absent pulmonary valve, sick sinus syndrome, and complete heart block underwent multiple remote cardiac surgeries	Fever and fatigue for three months with significant weight loss and acute kidney injury upon presentation	Intravenous methylprednisolone followed by tapering prednisolone and 15 weeks of antibiotics	Discharged well but poor renal recovery
Raybould JE et al USA	2016	55/M	History of alcohol abuse	Fever and heart failure symptoms for a week and acute kidney injury upon presentation	Two weeks of intravenous antibiotics prior to intravenous methylprednisolone followed by tapering prednisolone and total six months of antibiotics	Discharged well with good renal recovery
Vercellone J et al USA	2018	47/M	Nephrolithiasis Irritable bowel syndrome Mild depression	Fever with left flank pain and dark colour urine for two weeks and acute kidney injury upon presentation	Six weeks of antibiotics with doxycycline and rifampicin	Discharged well with good renal recovery
Bannon L et al Israel	2019	66/F	Hypothyroidism Diabetes mellitus Hypertension Hyperlipidaemia Gout Ischemic heart disease underwent coronary artery bypass graft and aortic valve replacement	Fatigue and loss of weight for two months with confusion for two days and acute kidney injury upon presentation	High dose prednisolone then taper down and four months of antibiotics	Discharged well with good renal recovery
Shaikh G et al USA	2020	66/M	Hypertension Hyperlipidaemia Barret’s oesophagitis	Acute left eye blindness due to retinal artery occlusion with nephrotic and nephritic syndromes	Short duration of prednisolone and four months of antibiotics with temporary haemodialysis	Discharged well with renal recovery not requiring haemodialysis
Guo S et al USA	2022	13/F	No known medical illness	Fever, chest and abdominal pain with acute kidney injury upon presentation	Antibiotics and valve replacement	Discharged well with good renal recovery
Shahzad MA et al USA	2023	33/M	Human immunodeficiency virus on highly active antiretroviral therapy Alcohol abuse Recent wisdom tooth extraction	Severe headache due to subarachnoid haemorrhage from right anterior cerebral artery mycotic aneurysm and nephritic syndrome	Antibiotics and valve replacement	Discharged well with good renal recovery

Transesophageal echocardiogram with long axis view showing an echogenic mass at the tip of both mitral valve leaflets causing eccentric (horizontal, anteriorly directed) mitral regurgitation jet during ventricular systole.

Conclusions:

Infection-related glomerulonephritis can manifest as rapidly progressive glomerulonephritis due to various diseases such as lupus nephritis and ANCA-associated glomerulonephritis especially in the case of infective endocarditis. Thorough history taking and physical examination is crucial to detect infection as the main culprit to avoid detrimental aggressive immunosuppressive therapy.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.