607 - Bartonella Henselae Infection in Pediatric Patient with Celiac and Superior Mesenteric Artery Vasculitis

Publication Number: 607.3860

Aliya V. Redd, University of Florida College of Medicine, Gainesville, FL, United States; Jonathan D. Kass, University of Florida College of Medicine, Gainesville, FL, United States; Keren S. Fishman, University of Florida College of Medicine, Gainesville, FL, United States; Joanna Chaffin, University of Fl, Gainesville, FL, United States; Leeandra Cleaver, UF Health Shands Children's Hospital, Gainesville, FL, United States; Ensar Yekeler, University of Florida College of Medicine, Gainesville, FL, United States; Renee F. Modica, University of Florida College of Medicine, Orlando, FL, United States; Mariana Ribeiro Rodero Cardoso, UF Health Shands Hospital, Gainesville, FL, United States; Varvara Probst, University of Florida, Gainesville, FL, United States

Background: Bartonella Henselae (B. Henselae) is a gram-negative bacillus and a known cause of Cat Scratch Disease, which typically presents with fever and unilateral lymphadenopathy (LAD). Due to B. Henselae’s tropism for endothelial tissues, extra-lymphatic manifestation mimicking small- or medium-vessel vasculitis have also been documented. However, large-vessel vasculitis is rarely reported.

Objective: We present a case of large-vessel vasculitis with lymph node involvement presumed secondary to B. Henselae infection.

Design/Methods: N/A

Results: A 15-year-old male with no past medical history presented with a one-month history of left inguinal LAD, abdominal pain, and unintentional weight loss. Initially, he presented to his primary care provider with 10 days of progressively worsening tender left-sided inguinal LAD. Despite ten days of Cephalexin followed by seven days of Clindamycin, the left inguinal LAD progressed, and he developed intermittent abdominal pain associated with non-bloody non-bilious emesis and an 18-pound weight loss, prompting hospitalization. Infectious workup revealed strongly positive serum B. Henselae IgM >1:256 and IgG > 1:1024 titers. Rheumatological evaluation showed negative P-ANCA and C-ANCA titers. A computed tomography (CT) of the abdomen and pelvis demonstrated inguinal and iliac lymphadenitis (Figure 1A) without hepatosplenic lesions. Due to atypical presentation, CT angiography of the aorta was performed and demonstrated inflammatory perivascular stranding and adventitial inflammation surrounding proximal superior mesenteric artery (SMA) (Figure 1B) and the celiac trunk (Figure 1C) without beading or stenosis. Excisional biopsy of lymph node was performed, and tissue histopathology showed partial effacement of its architecture by multiple granulomas with patchy necrosis and associated neutrophils (Figure 2). The patient was diagnosed with large-vessel celiac and SMA vasculitis, presumed secondary to B. Henselae. He was started on oral Doxycycline and Rifampin and discharged with close monitoring by a multidisciplinary team to determine the duration and efficacy of treatment.

Conclusion(s): Prior literature has shown B. Henselae-associated endocarditis to mimic PR3 C-ANCA positive pauci-immune vasculitis with a variety of manifestations including glomerulonephritis, hepatosplenomegaly, and cytopenia. Additionally, small-vessel vasculitis involving retinal and cutaneous vessels have also been described. However, no such cases of large-vessel (celiac truncus or SMA) vasculitis secondary to B. Henselae have been reported to date, conveying the uniqueness of this case.

Figure 1


Figure 2