Bacillary angiomatosis compatible with systemic manifestations: a  case report

Abstract

Bacillary angiomatosis is a rare infection caused by Bartonella henselae or Bartonella quintana, which usually affects patients with the human immunodeficiency virus (HIV) and causes cutaneous and extracutaneous lesions; it is usually benign, but potentially fatal due to systemic involvement. A 49-yearold male, HIV-positive patient was admitted for fever, weight loss, respiratory distress, lymphadenopathy, edema, and multiple widespread angiomatous papules, which began 2 months prior to admission. He had pancytopenia, hypoalbuminemia and hepatosplenomegaly. Skin biopsy showed a well-demarcated nodular lesion with an epidermal collaret that enclosed the dermis, and proliferation of capillaries with hyperplasia and hypertrophy of the endothelial cells. Bacilli were observed with Warthin-Starry stain. He was treated with cotrimoxazole, obtaining resolution of skin lesions and other systemic disorders; however, after stopping therapy, he was readmitted because of recurrence, then he died. This case shows a clinical-pathological correlation of bacillary angiomatosis, which was confirmed by Warthin-Starry stain. In addition, it was associated with systemic findings supported by the therapeutic response to antibiotics, the recurrence of the disease and the exclusion of other differential diagnoses. Despite the reduction of opportunist infections, this unusual disease could be present in some patients and affect skin and other tissues, which increases the probability of death, so physicians should recognize it and start therapy appropriately.