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From (Cat) Scratch: A Unique Presentation of Central Nervous System Bartonella Infection
Wilson Rodriguez1, Margarita Fedorova1, Lokesh Rukmangadachar1
1Neurology, Saint Louis University School of Medicine, Saint Louis, USA.
Cureus
|May 8, 2023
Summary
Central nervous system Bartonella infections are rare, but this case highlights Bartonella henselae causing multiple brain abscesses in an immunocompromised patient. Prompt diagnosis and treatment led to a full recovery, emphasizing Bartonella as a differential diagnosis.
Area of Science:
- Infectious Diseases
- Neurology
- Immunology
Background:
- Central nervous system (CNS) manifestations of Bartonella species are uncommon, typically presenting as meningitis, encephalitis, or optic neuritis.
- Immunocompromised individuals, particularly those on immunosuppressive therapy like high-dose prednisone for systemic lupus erythematosus, are at increased risk for opportunistic infections.
Observation:
- A 28-year-old woman with a history of systemic lupus erythematosus on high-dose prednisone presented with a four-month history of progressive, bilateral, painless vision loss.
- Brain magnetic resonance imaging (MRI) revealed numerous contrast-enhancing lesions throughout the cerebral and cerebellar hemispheres and brainstem.
- A brain biopsy confirmed infection with Bartonella henselae via polymerase chain reaction.
Findings:
- This case represents the first reported instance of multiple brain abscesses caused by CNS Bartonella infection in the medical literature.
- Treatment with doxycycline and rifampin resulted in significant improvement in the patient's vision and resolution of the brain lesions on follow-up MRI.
Implications:
- The findings underscore the importance of considering Bartonella infection in immunocompromised patients presenting with multiple brain abscesses, as it can mimic other CNS infections.
- Early and accurate diagnosis of Bartonella CNS infections is crucial for initiating prompt antimicrobial therapy, which can lead to complete clinical and radiological cure.
