ESPN 50th Annual Meeting

ESPN 2017


 
DISSEMINATED BARTONELLA HENSELAE INFECTION IN A CHILD RECEIVING MYCOPHENOLATE MOFETIL FOR IDIOPATHIC NEPHROTIC SYNDROME
Ranchin Bruno 1 Cheyssac Elodie 1 Laurent Audrey 1 Bertholet-Thomas Aurelia 1 Viremouneix Loic 2 Toumi Chadia 3 Bacchetta Justine 1

1- Pediatric Nephrology unit Hospices Civils de Lyon
2- Pediatric Radiology unit Hospices Civils de Lyon
3- Pediatric Infectiology unit Hospices Civils de Lyon
 
Introduction:

Mycophenolate mofetil (MMF) is an efficient steroid-sparing drug in steroid-dependent idiopathic nephrotic syndrome (SDNS). Infectious complications have been rarely reported in patients receiving only MMF.

 

 

Material and methods:

We report on a 7-year old girl receiving MMF for SDNS and developing disseminated Bartonella Henselae infection.

 

 

Results:

The patient was receiving MMF for one year when she presented fever. The daily dose of MMF was 920 mg/m²; it had been decreased from 1220 to 920 mg/m² 11 months before the onset of symptoms because of a MMF area under the curve of 114 mg.h/L. After 5 days of fever, clinical examination showed an isolated 15 mm-diameter pre-ear tragus lymph node. Blood formula was normal, whilst serum ALAT and gammaGT were increased (318 and 72 IU/L, respectively), serum protein C reactive subnormal (9.7 mg/L), blood EBV and CMV viral load and Bartonella Henselae serology were negative. Abdominal ultrasonography showed multiple abdominal lymph nodes (diameter, 10 to 22 mm) at liver and spleen hilums, with one liver and multiple spleen hypodense nodules. Bone marrow aspiration was normal. PCR for Bartonella Henselae was positive on surgical biopsy of the cervical lymph node performed after 13 days of fever. The child had a 5 year-old cat at home and played with kittens during the last weeks. MMF was withdrawn and prednisolone restarted at 10 mg every other day. The child received clarithromycin and amikacin for 10 days, and then clarithromycin for 4.5 months. Fever disappeared within 4 days and abdominal lymph nodes after 3 months.

 

 

Conclusions:

Disseminated Bartonella Henselae infection has been described in patients receiving a combination of immunosuppressive agents after transplantation. This case illustrates that it can also be observed in a patient receiving only MMF. Thus, direct contact between such patients and cats (especially kitten) should be avoided, and MMF exposure should be minimized if possible.