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Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient
BACKGROUND: Bartonella henselae (B. henselae) is considered a rare cause of granulomatous hepatitis. Due to the fastidious growth characteristics of the bacteria, the limited sensitivity of histopathological stains, and the non-specific histological findings on liver biopsy, the diagnosis of hepatic...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287964/ https://www.ncbi.nlm.nih.gov/pubmed/22269175 http://dx.doi.org/10.1186/1471-2334-12-17 |
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author | VanderHeyden, Thomas R Yong, Sherri L Breitschwerdt, Edward B Maggi, Ricardo G Mihalik, Amanda R Parada, Jorge P Fimmel, Claus J |
author_facet | VanderHeyden, Thomas R Yong, Sherri L Breitschwerdt, Edward B Maggi, Ricardo G Mihalik, Amanda R Parada, Jorge P Fimmel, Claus J |
author_sort | VanderHeyden, Thomas R |
collection | PubMed |
description | BACKGROUND: Bartonella henselae (B. henselae) is considered a rare cause of granulomatous hepatitis. Due to the fastidious growth characteristics of the bacteria, the limited sensitivity of histopathological stains, and the non-specific histological findings on liver biopsy, the diagnosis of hepatic bartonellosis can be difficult to establish. Furthermore, the optimal treatment of established hepatic bartonellosis remains controversial. CASE PRESENTATION: We present a case of hepatic bartonellosis in an immunocompetent woman who presented with right upper quadrant pain and a five cm right hepatic lobe mass on CT scan. The patient underwent a right hepatic lobectomy. Surgical pathology revealed florid necrotizing granulomatous hepatitis, favoring an infectious etiology. Despite extensive histological and serological evaluation a definitive diagnosis was not established initially. Thirteen months after initial presentation, hepatic bartonellosis was diagnosed by PCR studies from surgically excised liver tissue. Interestingly, the hepatic granulomas persisted and Bartonella henselae was isolated from the patient's enriched blood culture after several courses of antibiotic therapy. CONCLUSION: The diagnosis of hepatic bartonellosis is exceedingly difficult to establish and requires a high degree of clinical suspicion. Recently developed, PCR-based approaches may be required in select patients to make the diagnosis. The optimal antimicrobial therapy for hepatic bartonellosis has not been established, and close follow-up is needed to ensure successful eradication of the infection. |
format | Online Article Text |
id | pubmed-3287964 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-32879642012-02-28 Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient VanderHeyden, Thomas R Yong, Sherri L Breitschwerdt, Edward B Maggi, Ricardo G Mihalik, Amanda R Parada, Jorge P Fimmel, Claus J BMC Infect Dis Case Report BACKGROUND: Bartonella henselae (B. henselae) is considered a rare cause of granulomatous hepatitis. Due to the fastidious growth characteristics of the bacteria, the limited sensitivity of histopathological stains, and the non-specific histological findings on liver biopsy, the diagnosis of hepatic bartonellosis can be difficult to establish. Furthermore, the optimal treatment of established hepatic bartonellosis remains controversial. CASE PRESENTATION: We present a case of hepatic bartonellosis in an immunocompetent woman who presented with right upper quadrant pain and a five cm right hepatic lobe mass on CT scan. The patient underwent a right hepatic lobectomy. Surgical pathology revealed florid necrotizing granulomatous hepatitis, favoring an infectious etiology. Despite extensive histological and serological evaluation a definitive diagnosis was not established initially. Thirteen months after initial presentation, hepatic bartonellosis was diagnosed by PCR studies from surgically excised liver tissue. Interestingly, the hepatic granulomas persisted and Bartonella henselae was isolated from the patient's enriched blood culture after several courses of antibiotic therapy. CONCLUSION: The diagnosis of hepatic bartonellosis is exceedingly difficult to establish and requires a high degree of clinical suspicion. Recently developed, PCR-based approaches may be required in select patients to make the diagnosis. The optimal antimicrobial therapy for hepatic bartonellosis has not been established, and close follow-up is needed to ensure successful eradication of the infection. BioMed Central 2012-01-23 /pmc/articles/PMC3287964/ /pubmed/22269175 http://dx.doi.org/10.1186/1471-2334-12-17 Text en Copyright ©2012 VanderHeyden et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report VanderHeyden, Thomas R Yong, Sherri L Breitschwerdt, Edward B Maggi, Ricardo G Mihalik, Amanda R Parada, Jorge P Fimmel, Claus J Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient |
title | Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient |
title_full | Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient |
title_fullStr | Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient |
title_full_unstemmed | Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient |
title_short | Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient |
title_sort | granulomatous hepatitis due to bartonella henselae infection in an immunocompetent patient |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3287964/ https://www.ncbi.nlm.nih.gov/pubmed/22269175 http://dx.doi.org/10.1186/1471-2334-12-17 |
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