BARTONELLA (ROCHALIMAEA) QUINTANA INFECTION IN A SERONEGATIVE HEMODIALYZED PATIENT

Bartonella quintana is a reemerging pathogen responsible for trench fe ver, endocarditis, bacteremia, and bacillary angiomatosis. We previous ly reported the first case of a patient with B. quintana-induced chron ic adenomegaly, and here we present a report on a second patient. A he modialyzed patient with Sjogren's syndrome presented with mediastinal adenomegalies and secondary pancytopenia. All diagnostic investigation s remained negative, except that a Bartonella-like microorganism was i solated from a bone man ow biopsy. The isolate was identified as B. qu intana by a specific mouse polyclonal antibody and by determination of a partial gltA (citrate synthase-encoding) gene and 16S rRNA gene seq uences. DNA of the pathogen was also detected in the adenomegaly and i n the serum of the patient by PCR amplification of the gltA gene. Anti -B. quintanna antibodies were never detected in the patient's serum th roughout the 12-month follow-up but were detected in the serum of the patient's cat. The patient's outcome was favorable after treatment wit h gentamicin, Chronic adenomegaly in seronegative patients is a new cl inical entity due to B. quintana.