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Open Access Case report

Granulomatous hepatitis due to Bartonella henselae infection in an immunocompetent patient

Thomas R VanderHeyden1*, Sherri L Yong2, Edward B Breitschwerdt3, Ricardo G Maggi3, Amanda R Mihalik1, Jorge P Parada4 and Claus J Fimmel1

Author Affiliations

1 Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA

2 Department of Pathology, Loyola University Medical Center, Maywood, IL 60153, USA

3 Intracellular Pathogens Research Laboratory, Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Caroline State University, Raleigh, NC 27606, USA

4 Division of Infectious Diseases, Loyola University Medical Center, Maywood, IL 60153, USA

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BMC Infectious Diseases 2012, 12:17  doi:10.1186/1471-2334-12-17

Published: 23 January 2012

Abstract

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.

Keywords:
Granulomatous hepatitis; Bartonella henselae; Diagnosis; Treatment