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Bartonella henselae masquerading as possible gamma–delta T-cell lymphoma in a paediatric patient with 22q11.2 deletion syndrome
  1. Kimberly Davis1,
  2. Lauren Battaglia1,
  3. Beena Kumar2 and
  4. Samar Ojaimi3
  1. 1Department of Paediatrics, Monash Children's Hospital, Clayton, Victoria, Australia
  2. 2Department of Anatomical Pathology, Monash Medical Centre, Clayton, Victoria, Australia
  3. 3Department of Immunology, Monash Medical Centre, Clayton, Victoria, Australia
  1. Correspondence to Dr Kimberly Davis; drkimberlyjdavis{at}gmail.com

Abstract

A 14-year-old boy with 22q11.2 deletion syndrome and a right ventricular to pulmonary artery xenograft conduit presented to an Australian tertiary children’s hospital with prolonged fevers, weight loss, splenomegaly and a high proportion of gamma–delta T cells in peripheral blood and bone marrow, concerning for possible gamma–delta T-cell lymphoma. However, investigations did not reveal evidence of lymphoma or autoimmune disease. After 5 months of intermittent fever episodes and ongoing symptoms, he was found to have an extremely high Bartonella henselae titre (8192) on serological testing, with the organism also detected on blood PCR. After 6 months of oral azithromycin and rifampicin, with complete resolution of his symptoms 3 months into treatment, his blood PCR was negative and gamma–delta T cells in peripheral blood were decreasing. The B. henselae titre remained unchanged for some time, but decreased to 2048 around 1 year after treatment was started.

  • immunology
  • infections
  • congenital disorders

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Footnotes

  • Contributors KD wrote the first draft and made changes to subsequent drafts. LB and BK made suggestions for the final edit. SO made substantial changes and contributions at each stage of the writing process.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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