Can Lymphadenopathy Guide the Diagnosis of Hepatosplenic Bartonella Infection in Pediatric Renal Transplant Recipients? What Is the Optimal Treatment and Follow-Up Duration?

BACKGROUND

Cat scratch disease (Bartonella henselae) typically presents with fever and granulomatous lymphadenopathy. Immunocompromised individuals, particularly organ transplant recipients, are at increased risk of severe infections with potential multisystem involvement. In renal transplant recipients, the optimal duration of treatment and antibiotic selection remain uncertain due to drug interactions and nephrotoxicity concerns.

METHODS

We present a 13-year-old male renal transplant recipient who was diagnosed with hepatosplenic Bartonella infection after presenting to the pediatric infectious diseases department with right mandibular lymphadenopathy. The patient underwent a 1-year treatment course and was followed for 2 years, during which no relapse or graft rejection was observed.

RESULTS

The patient initially presented with right submandibular swelling and tender lymphadenopathy. Despite empirical antibiotic therapy, persistent fever and progressive lymphadenopathy led to further investigation. Serologic testing confirmed Bartonella henselae infection, prompting systemic imaging. Although abdominal ultrasound was normal, abdominal MRI revealed focal hepatic and splenic lesions, leading to a diagnosis of invasive Bartonella infection. Due to drug interactions, the patient was treated with trimethoprim-sulfamethoxazole and doxycycline, with a reduction in immunosuppressive therapy. By 6 months, lymphadenopathy and liver lesions had regressed; however, splenic lesions persisted, requiring prolonged treatment. Therapy was completed after 1 year, and no recurrence was observed during 2 years of follow-up. The patient remained stable with no graft rejection.

CONCLUSIONS

Hepatosplenic Bartonella infection in renal transplant recipients may require prolonged antimicrobial therapy. Given the risk of relapse and the need to balance immunosuppressive therapy, an individualized treatment duration should be considered. Imaging modalities play a crucial role in monitoring treatment response. Further studies are needed to establish optimal treatment strategies in immunocompromised patients.