Ultrasound imaging as the basis of a clinical diagnosis of systemic bartonellosis in a patient after bone marrow transplantation. A case report
Aleksandra Krasowska-Kwiecień1,2, Jolanta Goździk2,3, Magdalena Woźniak2, Wojciech Czogała2
1 Department of Transplantology, Division of Clinical Immunology and Transplantation, Jagiellonian University Medical College, Krakow, Poland
2 Department of Transplantation, Children’s University Hospital, Krakow, Poland
3 Department of Immunology, Division of Clinical Immunology and Transplantation, Jagiellonian University Medical College, Krakow, Poland
Correspondence: Aleksandra Krasowska-Kwiecień, MD, PhD, Department of Transplantology, Division of Clinical Immunology and Transplantation, Jagiellonian University Medical College, Wielicka 265, 30-663 Krakow, Poland, tel.: +48 126 582 011, e-mail: email@example.com
Infections in immunocompromised patients after hematopoietic stem cell transplantation can have a severe and atypical course. Some opportunistic pathogens are difficult to detect in microbiological tests, and that is why treatment success depends on an accurate clinical diagnosis. This article presents a case of a 7-year-old girl with severe aplastic anemia treated with bone marrow transplantation with post-transplantation period complicated by persistent, hectic fever, with peak episodes of 39–40°C, lasting several weeks. Repeated microbiological tests failed to reveal the etiological agent, and empirical anti-infective treatment was ineffective. In the fourth week of fever, imaging showed multiple foci resembling abscesses in the patient’s internal organs and, subsequently, in soft tissues. The characteristics of these changes and data concerning environmental exposure led to the clinical diagnosis of cat scratch disease (bartonellosis) with multi-organ involvement and enabled the targeted treatment to be implemented. Fever subsided and organ lesions regressed. In this case, repeated ultrasound imaging was the basic diagnostic tool that helped arrive at a correct diagnosis and implement effective treatment of this life-threatening complication after hematopoietic stem cell transplantation.