Dr Sharafuddin Shah Bin Rhasbudin Shah, Dr Hugh McGann, Dr Jayana Devathasan
1Te Whatu Ora Waikato (Waikato Hospital), , New Zealand
Biography:
Sharafuddin Shah graduated from the University of Otago in 2012. He is undertaking dual training in Nephrology and General Medicine. He is currently a second-year renal advanced trainee at Waikato Hospital. He is interested in glomerulonephritis and is presently a Glomcon Podocin fellow batch 2024/2025. He is also currently taking the Kidney Pathology Certificate Course administered by Glomcon.
Abstract:
Although Bartonella hensalae is the most common cause of culture negative endocarditis in North America, the incidence of Bartonella hensalae endocarditis in humans in New Zealand is considered rare.
We report a case of necrotizing crescentic PR3 ANCA positive, full house immune complex mediated non-exudative glomerulonephritis, which presents with a new severe renal impairment in a 17-year-old girl. Preliminary search for infection revealed no underlying cause hence she was treated with immunosuppression with good initial creatinine response. However, she had a relapse shortly afterwards. On deeper investigation, she was later found to be positive for Bartonella hensalae serology; although no vegetations detected on serial transesophageal echocardiograms, the presence of endocarditis was confirmed on PET scan. Her treatment plan was changed to Doxycycline and Rifampicin and her immunosuppression was discontinued with excellent response.
This case highlights the importance of a thorough investigation for infection in patients who present with ANCA positivity and necrotising glomerulonephritis. In particular, invasive Bartonella infection should be considered in patients with risk factors and an atypical clinical presentation.