Bartonella henselae infection-associated vasculitis and crescentic glomerulonephritis leading to renal allograft loss.

Bartonella henselae (BH) is the main cause of cat scratch disease (CSD), which more typically presents as a self-limited localized suppurative lymphadenopathy in immunocompetent individuals. In contrast, immunocompromised patients commonly have systemic disease with life-threatening complications. In addition to the angioproliferative lesions, such as bacillary angiomatosis, an increasing number of immune post-infectious complications are being recognized with BH infections, including glomerulonephritis, vasculitis, hemophagocytic syndrome, and neurological problems. We report the case of a renal transplant recipient who developed CSD in the second year post transplantation. In addition to prolonged fever and generalized lymphadenopathy and splenomegaly requiring differentiation from a post-transplant lymphoproliferative disorder, the course was complicated by the development of dermal leukocytoclastic vasculitis and pauci-immune necrotizing and crescentic glomerulonephritis, which led to failure of the renal graft. Glomerulonephritis as a complication of CSD has never been described in a kidney allograft, to our knowledge. Awareness of the diverse clinical symptoms associated with BH, including granulomatous/suppurative lesions and other less common complications can lead to more rapid and accurate diagnosis. Also, as recommended by the current guidelines, a thorough history of pet ownership should be part of the clinical evaluation before and after transplantation for all transplant recipients.

Transcutaneous bilirubinometry: clinical application.

Simultaneous estimations of serum and transcutaneous bilirubin were done in 105 healthy, full term, jaundiced newborns. A good correlation was found between the transcutaneous and serum bilirubin values with coefficient of correlation 0.774. The observed sensitivity was 90%, specificity 78% and positive predictive value 64% at mean serum bilirubin concentration of 9.92 mg/dl. Two action levels at transcutaneous bilirubin values 15 and 18 were also generated that correlated with low and high serum bilirubin values; they can therefore be used for screening of jaundiced full term babies. This study indicates that the transcutaneous bilirubin meter is useful for screening of jaundiced neonates.