A Case Report of C-ANCA Positive Bartonella Endocarditis Associated Glomerulonephritis = A Case Report of C-ANCA Positive Bartonella Endocarditis Associated Glomerulonephritis

다국어 초록 (Multilingual Abstract)

Background: Bartonella endocarditis is very rare in South Korea. Some bacterial endocarditis can involve the kidney. This is the first report of C-ANCA positive Bartonella endocarditis-associated glomerulonephritis in South Korea. Case presentation: A 67-year-old man complained 7kg weight loss with anorexia over the past 6 months. Serum creatinine was 4.35 mg/dL. Albumin/globulin ratio was reversed and the ratio of spot urine protein/creatinine was 1.1. Bone marrow exam showed normocellular marrow without monoclonality of plasma cells. There were two old vegetations on transesophageal echocardiography. Blood cultures of two couple were negative. The renal histology findings demonstrated global sclerosis, mesangial proliferation, crescent formation and diffuse glomerular capillary walls thickened with deposits of C3, IgM and C1q. The level of C3 was decreased to 43.9 mg/dL and C-ANCA was positive. In further history findings, he has drunken deer blood. So, We examed Q fever, Legionella and Bartonella antibody test and Bartonella IgG ab was elevated to 1: 2,048. Azotemia and proteinuria were not improved though doxycycline and rifampin treatment for 8 weeks. But these were improved after steroid therapy for 6 weeks with same antibiotics. Conclusions: It is necessary to evaluate rare organism like Bartonella infection in the BCNE. In addition, if there are azotemia and proteinuria, we should consider renal biopsy to rule out the renal complication of endocarditis-associated glomerulonephritis and for early aggressive treatment.