microscopic study showed extracapillary proliferation including more than 50% of glomeruli associated with endocapillary proliferation and fibrinoid necrosis. Direct immunoflureoscence staining showed intense IgM, C3 and C1q deposits (figure 1B). Four days after starting antibiotics, the patient presented a spontaneous right humeral artery aneurism, which necessi- tated surgical resection. Bartonella henselae immunoglobulin- G titer at 1/4100 was detected. Based on these findings, crescentic glomerulonephritis and mycotic aneurism secondary to Bartonella endocarditis were diagnosed. Doxycycline was initiated and continued for 8 weeks. The patient’s condition improved with complete disappearance of asthenia, purpura and arthralgias. Acute phase response, antinuclear antibodies and PR3-ANCA disappeared and C3 normalized. Creatininemia was at 120 mmol/L and proteinuria decreased to 1 Gr/24 h at 2 months. Discussion Subacute bacterial endocarditis is a well-known condition asso- ciated with systemic features, septic emboli and immunological disturbances. Bartonella henselae is an exceptional etiology of blood-negative subacute endocarditis for which there are ap- proximately 50 reports [1,2]. Fever is absent in 30% of cases which could induce a delay in diagnosis and/or misdiagnosis. Mycotic aneurism appears to be exceptional in Bartonella hen- selae endocarditis, and only one cerebral aneurism has been reported [3]. Presence of ANCA has previously been reported in subacute streptococcal endocarditis, but with only another case of PR3-ANCA in Bartonella endocarditis [4,5]. Bartonella endo- carditis remains exceptional, such that in patients with blood- negative endocarditis early serological and molecular assays should be considered, even in patients without epidemiological risk factors and without fever, as illustrated in the present case. A combination of doxycycline and gentamicin is usually effec- tive, although because of renal toxicity aminoside was not used in the present case. Disclosure of interest: the authors declare that they have no conflicts of interest concerning this article. References [1] Dreier J, Vollmer T, Freytag C et al. Culture negative infectious endocarditis caused by Bartonella ssp.: 2 case reports and a review of literature. Mirobiol Inf Dis 2008;61:476-83. [2] Gupta D, Green J, Franco-Paredes C, Lerakis S. Challenges in the clinical management of blood culture negative endocarditis: case of Bartonella henselae infection. Am J Med 2011;124:1-2. [3] De La Blanchardière A, Fournier PE, Haustraete E, Cheyron D, Lepage O, Verdon R. Infective endocarditis due to Bartonella henselae following a rupture of a cerebral aneurism. Med Mal Infect 2009;39: 394-6. [4] Hanf W, Serre JE, Salmon JH et al. Glome ´ rulone ´ phrite rapidement progressive a ` ANCA re ´ ve ´ lant une endocardite infectieuse subaigue ¨. Rev Med Int 2011;32:e116-8. [5] Turner JW, Pien BC, Ardoin SA et al. A man with chest pain and glomerulonephritis. Lancet 2005;365:2062. Clémentine Salvado 1 , Arsène Mekinian 1 , Philippe Rouvier 2 , Patricia Poignard 3 , Isabelle Pham 3 , Olivier Fain 1 1 Université Paris 13, AP–HP, hôpital Jean-Verdier, service de médecine interne, 93143 Bondy, France 2 Université Paris 7, AP–HP, hôpital Pitié-Salpêtrière, service d’anatomopathologie et histologie, 75013 Paris, France 3 Université Paris 13, AP–HP, hôpital Jean-Verdier, service de cardiologie et explorations fonctionnelles, 93143 Bondy, France Correspondence: Arsène Mekinian, Université Paris 13, AP–HP, hôpital Jean-Verdier, service de médecine interne, avenue du 14-Juillet, 93143 Bondy, France. arsene.mekinian@jvr.aphp.fr Received 18 March 2012 Accepted 31 July 2012 Available online 15 October 2012 ß 2012 Published by Elsevier Masson SAS. http://dx.doi.org/10.1016/j.lpm.2012.07.031 Polyradiculonévrite aiguë révélant une neurosyphilis chez un patient immunocompétent Acute polyradiculoneuropathy revealing neurosyphilis in an immunocompetent patient Les manifestations neurologiques de la syphilis sont poly- morphes et sont actuellement en recrudescence dans le monde à cause de la pandémie du sida. La méningo-encéphalite syphilitique suivie du tabès, sont les atteintes les plus fréquem- ment rapportées [1]. En revanche, les polyradiculonévrites font partie des manifestations rarement décrites au cours de la syphilis [2,3]. Nous rapportons un cas de polyradiculonévrite aiguë révélant une neurosyphilis chez un sujet immunocompé- tent et nous soulignons l’intérêt des sérologies syphilitiques dans le diagnostic des polyradiculoneuropathies dont la cause n’a pas été établie. Observation Un homme de 45 ans, jardinier, a consulté aux urgences neurologiques pour une impotence fonctionnelle indolore des 2 membres inférieurs (MI), apparue d’une façon subaigüe en 48 heures, sans troubles sphinctériens associés. Il n’y avait, ni d’antécédent personnel ni familial, ni prise médicamenteuse particulière. L’anamnèse n’a pas mis en évidence une infection respiratoire ou gastro-intestinale ou une vaccination récentes ; une infection sexuellement transmissible ou une éruption cutanée. Le patient n’a pas signalé de rapports à risque. À l’examen clinique, le patient était apyrétique, en bon état 1061 Letters to the editor tome 42 > n86 > juin 2013