{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T05:38:24Z","timestamp":1777441104281,"version":"3.51.4"},"reference-count":30,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>A 74-year-old patient presented with constitutional symptoms and was found to have acute kidney injury. He was known to have a prosthetic aortic valve. He was febrile with splenomegaly and vasculitic lesions on both hands. Nephritic screen revealed strongly positive cytoplasmic-antineutrophil cytoplasmic antibodies (c-ANCA). Differential diagnosis thus included a small vessel vasculitis or infective endocarditis. Transoesophageal echocardiography demonstrated no vegetations and serial blood cultures were negative. Immunosuppression for presumed granulomatosis with polyangiitis (Wegeners granulomatosis) was therefore instituted. The patient deteriorated, requiring multi-organ support. Renal biopsy showed a proliferative glomerulopathy and complements were low. Atypical screen for culture negative endocarditis revealed a strongly positive IgG-antibody titre against<jats:italic>Bartonella henselae<\/jats:italic>. Immunosuppression was discontinued and treatment for chronic Bartonellosis commenced. The patient made a remarkable recovery. His renal function quickly returned to normal, and ANCA titres and complements normalised. He was discharged home after completing a 6 week course of antibiotic therapy.<\/jats:p>","DOI":"10.1136\/bcr.08.2011.4705","type":"journal-article","created":{"date-parts":[[2011,12,3]],"date-time":"2011-12-03T00:40:52Z","timestamp":1322872852000},"page":"bcr0820114705","source":"Crossref","is-referenced-by-count":4,"title":["Complements do not lie"],"prefix":"10.1136","volume":"2011","author":[{"given":"Stefanie Christina","family":"Robert","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne Helen","family":"Forbes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Surusch","family":"Soleimanian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia S","family":"Hadley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2011,12,1]]},"reference":[{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.1","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0b013e3283323538"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.2","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-010-1424-4"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.3","doi-asserted-by":"publisher","DOI":"10.1159\/000228645"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.4","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-005-0176-z"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.5","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200001)43:1<226::AID-ANR27>3.0.CO;2-Q"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.6","doi-asserted-by":"publisher","DOI":"10.1067\/mhl.2003.2"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.7","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2005101048"},{"issue":"1 Suppl 52","key":"2025042708200485000_2011.nov28_1.bcr0820114705.8","first-page":"S108","article-title":"New advances in the pathogenesis of ANCA-associated vasculitides.","volume":"27","author":"Chen","year":"2009","journal-title":"Clin Exp Rheumatol"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.9","doi-asserted-by":"publisher","DOI":"10.1097\/RHU.0b013e318164187a"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.10","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.088302"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.11","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/ar392","article-title":"Staphylococcus aureus and Wegener\u2019s granulomatosis.","volume":"4","author":"Popa","year":"2002","journal-title":"Arthritis Res"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199607043350103"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.humimm.2003.09.013"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.14","first-page":"17","article-title":"The current status of neutrophil cytoplasmic antibodies","volume":"19","author":"van der Woude","year":"2007","journal-title":"Curr Opin Rheumatol"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.15","doi-asserted-by":"publisher","DOI":"10.1038\/nm968"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.16","doi-asserted-by":"publisher","DOI":"10.1038\/nm.1874"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.17","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2009.123"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.18","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.73.2.110"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.19","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep017"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.20","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1755.1998.00807.x"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.21","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1988.03720090037031"},{"key":"2025042708200485000_2011.nov28_1.bcr0820114705.22","unstructured":"Centre for disease and control and prevention. 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