Into the unknown: Diagnosing mysterious brain lesions.

Area of Science:

• Infectious Diseases
• Neurology
• Transplantation Immunology

Background:

• Central nervous system (CNS) infections pose significant risks for immunocompromised individuals.
• Bartonella henselae, a zoonotic pathogen causing cat-scratch disease, can lead to severe manifestations in immunocompromised hosts.
• Brain abscesses are a rare but serious neurological complication of Bartonella henselae infection.

Purpose of the Study:

• To discuss the diagnostic approach for CNS infections in immunocompromised patients.
• To present a case of Bartonella henselae brain abscess in a pancreas-kidney transplant recipient.
• To emphasize the utility of advanced diagnostic techniques in identifying rare pathogens.

Main Methods:

• Case presentation of a pancreas-kidney transplant recipient with neurological symptoms.
• Cerebrospinal fluid (CSF) analysis including metagenomic next-generation sequencing (mNGS).
• Review of diagnostic strategies for CNS infections in immunocompromised hosts.

Main Results:

• Multiple brain abscesses were identified in the transplant recipient.
• CSF metagenomic next-generation sequencing was crucial for identifying Bartonella henselae as the causative agent.
• The patient's immunocompromised status contributed to the atypical presentation and severity.

Conclusions:

• Metagenomic next-generation sequencing is a valuable tool for diagnosing CNS infections caused by rare pathogens like Bartonella henselae.
• Early and accurate diagnosis is critical for effective management of CNS infections in immunocompromised patients.
• This case underscores the importance of considering diverse pathogens in the differential diagnosis of brain abscesses in transplant recipients.