A potentially Cat-astrophic Missed Diagnosis: Systemic Autoimmune Disease or Something more Sinister
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Publication Date
2025
Keywords
oregon, ppmc, oregon gme
Disciplines
Medical Education | Pharmacy and Pharmaceutical Sciences
Abstract
Introduction: Disseminated bartonella infection has a mortality rate approaching 10%. Clinical presentation of bartonellosis can mimic systemic autoimmune disease. Traditional testing may not identify the organism, so a high degree of suspicion is warranted in patients with risk factors. Case Presentation: 32M with history of Tetralogy of Fallot with prosthetic pulmonary valve presented with fatigue x3 months. Reported severe splenomegaly, pancytopenia requiring transfusions, and renal failure requiring hemodialysis. Given concern for lupus-like syndrome, treated with steroids + cyclophosphamide. Persistent fevers despite broad antibiotics. Second opinion of renal biopsy: Postinfectious GN. Immunostains ruled out lupus-like disorder. Negative blood cultures, TEE, and serologies for HIV, EBV, CMV, hepatitis, coxiella, brucella, and bartonella. Takeaways: • Disseminated bartonellosis can mimic autoimmune diseases. • Patients with exposure to cats and with valvular heart disease are at highest risk. • False negatives common with serologies, blood cultures, and traditional PCR. • In patients with higher indices of suspicion, enhanced PCR’s at specialty labs, valve cultures, ddPCR, or cell-free DNA testing can enhance sensitivities.
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Pharmacy
