2019 Volume 52 Issue 2 Pages 109-114
The patient was a 67-year-old male, who had been on hemodialysis due to diabetic nephropathy for 3 years. He was admitted with a 3-day history of weakness and disturbance of consciousness. After admission, his general condition gradually improved, but laboratory tests demonstrated sustained elevated C-reactive protein levels. Transthoracic echocardiography revealed vegetation on the mitral valve, but the patient’s blood cultures remained negative. Further investigation determined that he had been in contact with a cat prior to admission; therefore, we investigated his Bartonella henselae antibody titer. An immunofluorescence-based assay confirmed that the patient was suffering from a Bartonella infection. He was treated with intravenous cefotaxime and recovered. Hemodialysis patients are at high risk of infectious disease, and in some cases it is difficult to identify the causative microorganisms. This case showed that if a hemodialysis patient exhibits chronic inflammation despite being well and afebrile, there is a possibility of infection. In such cases, a Bartonella infection should be considered when blood culture-negative endocarditis is suspected.
