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Abstract Details

A Case of Cerebral Vasculitis Due to Neurobartonellosis
Infectious Disease
P12 - Poster Session 12 (12:00 PM-1:00 PM)
13-018

To report a case of secondary CNS vasculitis due to neurobartonellosis in the adult population.
Neurologic manifestations of Cat-Scratch Disease (CSD) are uncommon and mostly present as encephalopathy. Only two pediatric case reports of suspected Bartonella henselae associated CNS vasculitis have been reported. To our knowledge, no adult cases are known. 

Case report and literature review.
We report the case of a 60-year-old right-handed woman with hypertension, hyperlipidemia, hypothyroidism, reported family history of primary angiitis of the CNS in the mother, who presented with a three-week history of recurrent thunderclap headaches accompanied by photophobia, phonophobia, nausea, and vomiting. She reported one brief episode of slurred speech, expressive aphasia, right facial droop, and right hemiparesis suggestive of a TIA. Physical evaluation was unremarkable. CT head was negative; CTA head and neck suggested fibromuscular dysplasia in bilateral cervical internal carotid arteries and distal right vertebral artery. MRI brain showed no correlating abnormalities. An angiogram revealed multivessel intracranial medium and large vessel beading without evidence of vasospasm, suggesting vasculitis. Intracranial vessel wall MRI showed diffuse vessel wall enhancement. Transcranial Doppler showed no evidence of elevated velocity. CSF studies, serum inflammatory and infectious studies had been negative thus far. Empiric high dose intravenous steroids lead to complete symptom resolution. Final infectious workup revealed strongly positive serum Bartonella IgM titer of 1:256 and negative IgG, consistent with her reported cat exposure. She was started on an outpatient two-week course of doxycycline, rifampin, and oral steroids. Four weeks later, repeat vessel wall MRI brain, MRA head, and Bartonella serologies showed improvement.

Bartonella henselae is an uncommon cause of CNS vasculitis, especially without encephalopathy as the presenting symptom. We suggest assessing animal exposure in patients with undetermined vasculitis etiology. Non-invasive imaging such as vessel wall MRI can be useful in assessing improvement over time.
Authors/Disclosures
Meryim Poursheykhi, MD (Vanderbilt University Medical CEnter)
PRESENTER 		Dr. Poursheykhi has nothing to disclose.
Tanu Garg, MD (Houston Methodist Hospital) Dr. Garg has nothing to disclose.
Christian Cajavilca, MD (LSUHSC-Shreveport) No disclosure on file
Rajan R. Gadhia, MD (Houston Methodist Hospital, WCMC) Dr. Gadhia has nothing to disclose.