Recurrent Pyogenic Granuloma with Satellitosis – A Localized Variant of Bacillary Angiomatosis?

Abstract

A 27-year-old male patient had recurrent pyogenic granuloma with satellitosis. Histologically, Warthin-Starry staining of the lesions revealed clumps of dark bacilli as found in patients with bacillary angiomatosis. IgG antibodies against Bartonella (Rochalimaea) henselae were elevated as shown by an indirect immunofluorescence assay. The patient did not present an obvious risk for HIV infection or immunosuppression, and no antibodies against HIV-1 and HIV-2 were found. Recurrent pyogenic granuloma with satellitosis may be a localized variant of bacillary angiomatosis.

Is pyogenic granuloma associated with Bartonella infection?

“…12 This hypothesis was supported by findings that Bartonella was capable of inducing angiogenesis in tissue culture. 13,14 Bartonella spp are extracellular bacteria that are easily detected on immunohistochemical examination in valve tissue specimens from patients with Bartonella endocarditis or from patients with cutaneous bacillary angiomatosis.…”

Pyogenic Granuloma: Pyogenic Again? Association between Pyogenic Granuloma and Bartonella

“…One particularly notable case report described an immunocompetent young male patient who had recurrent PG with satellitosis. 4 Biopsy and examination with Warthin±Starry staining showed the presence of Bartonella bacilli in the lesions, and the patient was shown to have positive serology for Bartonella antibodies. Another case report described multiple, eruptive PG with over 200 lesions in an immunocompetent patient.…”

“…In further support of our question, a case report in 1994 was suggestive of an association between PG and Bartonella infection. 4 It described an immunocompetent patient who experienced recurrent PG with satellitosis and was found to have serological evidence of Bartonella infection, as well as positive lesion staining for Bartonella. The objective of our study was to determine through a case-control study whether there is an association between Bartonella infection and PG.…”

Pediatric Dermatology Photoquiz: Multiple Erythematous Papules on the Back

“…Bacillary angiomatosis, known to occur more commonly in HIV‐positive individuals, is a close clinical and histologic differential diagnosis. Itin et al found clumps of dark‐staining bacilli in their case of pyogenic granuloma with satellitosis, prompting them to call it a localized variant of bacillary angiomatosis. Warthin–Starry stain was negative in our case, and furthermore, a mixed‐cell inflammatory infiltrate was lacking.…”