Bacillary angiomatosis in HIV-positive patient from Northeastern Brazil: a case report / Angiomatose bacilar em paciente HIV positivo no nordeste brasileiro: relato de caso

It is a report of disseminated bacillary angiomatosis (BA) in a 23-year-old female patient, who is HIV-positive and with fever, weight loss, hepatomegaly, ascites, and papular-nodular skin lesions. The clinical and diagnostic aspects involved in the case were discussed. Bacillary angiomatosis must always be considered in the diagnosis of febrile cutaneous manifestations in AIDS.

Relato de angiomatose bacilar (AB) disseminada em paciente do sexo feminino de 23 anos, HIV positiva, com febre, emagrecimento, hepatomegalia, ascite e lesões de pele pápulo-nodulares. Foram discutidos os aspectos clínicos e diagnósticos envolvidos no caso. Angiomatose bacilar deve sempre ser considerada no diagnóstico de doença febril com manifestações cutâneas na AIDS.

Bronchoscopy and endobronchial disease in patients with human immunodeficiency virus infection.

The natural history of human immunodeficiency virus (HIV) infection has been significantly altered since the advent of antiretroviral therapy (ART). However, lung diseases are still common in these patients. This makes flexible fibreoptic bronchoscopy a valuable diagnostic tool. Knowledge of the visual appearance of various diseases would be of utmost importance to the bronchoscopist. Timely recognition of the endobronchial appearance of these diseases can narrow the differential diagnosis and potentially mitigate an avoidable delay in the diagnosis.

Angiomatosis bacilar por Bartonella quintana en un paciente con infección por virus de inmunodeficiencia humana / Bacillary angiomatosis caused by Bartonella quintana in an human immunodeficiency virus positive patient

We report the first case of bacillary angiomatosis due to Bartonella quintana affecting a Chilean a HIV positive patient in Chile. He was a 27 years old, heterosexual male, indigentman known to be HIV positive serological status known from September, 2003, under irregular medical control. On April, 2005, he presented a progressive abscess in the frontal region and erythematous papules in the extremities, that extended to face, thorax and mucoses, becoming nodular and violaceous lesions. Bacillary angiomatosis diagnosis was initially sustained on account of the clinical manifestations, and was confirmed by serology and Warthin Starry staining from a skin biopsy. The etiological agent was identified as Bartonella quintana through universal RPC performed from a cutaneous nodule to detect 16S rRNA gen. Azithromycin plus ciprofloxacin was started, besides of anti retroviral therapy antiretroviral, with the lesions being progressively disappearing.

Reportamos el primer caso de angiomatosis bacilar por Bartonella quintana en un paciente con infección por VIH en nuestro país. Este corresponde a un hombre de 27 años, heterosexual, indigente, seropositivo para VIH conocido desde septiembre de 2003, en control irregular. En abril de 2005, el paciente desarrolló un aumento progresivo de volumen en la región frontal y aparición de pápulas eritematosas en las extremidades, que luego se extendieron a la cara, tórax y mucosas, tornándose nodulares y violáceas. El diagnóstico de angiomatosis bacilar se planteó inicialmente por el cuadro clínico del paciente, siendo confirmado por serología y tinción de Warthin Starry positiva en la biopsia de piel. El agente causal se identificó como Bartonella quintana por RPC universal para el gen del 16S ARNr de un nódulo cutáneo. Se inició terapia antimicrobiana con azitromicina y ciprofloxacina, además de terapia antiretroviral, con desaparición de las lesiones en forma progresiva.

Angiomatose bacilar pós-transplante renal: apresentação de um caso / Bacillary angiomatosis after kidney transplantation

A bartonela causa a Doença da arranhadura do gato, mas em imunossuprimidos pode levar à doença sistêmica, denominada angiomatose bacilar.Descrição do caso: Masculino, 15 anos, transplantado há 3 anos, em uso de FK, MMF e prednisona com função renal preservada. Refere tumoraçãoavermelhada e dolorosa na região mandibular esquerda há 30 dias, com febre elevada há 7 dias. Esta em regular estado geral, descorado, 39ºC, commassa submandibular de 4cm de diâmetro, consistência carnosa com vesículas na superfície e hepato-esplenomegalia. Bx da massa compatível com Angiomatose Bacilar. Evoluiu bem com Cloranfenicol e Eritromicina. Apresentou elevação da creatinina sérica, sendo feita hipótese de rejeição e realizadopulso de metilprednisolona com normalização da função renal. Conclusões: Como a soroprevalência de Bartonela, em gatos, é elevada em nosso meio, deve-se estar alerta para seu diagnóstico. Pacientes imunossuprimidos podem apresentar formas sistêmicas graves de infecções comuns que, pelararidade, podem ser diagnosticadas tardiamente e carrear maior morbidade.

Bartonela sp causes cat scratch disease but in immunosuppressed hosts it can be associated with a systemic disease named bacillary angiomatosis.Description of case: A 15-year old boy with a successful kidney transplant for 3 years had been treated with FK, MMF and prednisone. He reported ared and painful mass in the left submandibular area for 30 days, and high fever for the last 7 days. He looked sick, pale and had a submandibular mass of 4cm in diameter with vesicles in its surface and hepatosplenomegaly. Biopsy of the mass was suggestive of bacillary angiomatosis. He was treated withchloramphenicol and erythromycin and had a favorable course. An increase of creatinine, interpreted as rejection, was successfully managed with a pulseof methylprednisolone. Conclusions: As the prevalence of bartonelosis in cats is elevated in our country, physicians should be aware of that diagnosticpossibility. Immunocompromised hosts may present rare systemic forms of common diseases that can be diagnosed late and produce sequels.

What do we (not) know about the human bartonelloses?

The human bartonelloses are a group of diseases with a rapidly increasing clinical spectrum. Well known manifestations such as Carrion's disease, trench fever, cat-scratch disease, and bacillary angiomatosis are examples of Bartonella spp. infection. Along with these diseases, recurrent bacteremia, endocarditis, septicemia, erythema nodosum, erythema multiforme, trombocytopenic purpura and other syndromes have been reported having been caused by bacteria of this genus. The infectious process and the pathogenesis of these microorganisms are poorly understood. The bartonelloses may have a benign and self-limited evolution in a host, or a potentially fatal one. These bacteria can provoke a granulomatous or an angioproliferative histopathologic response. As these diseases are not yet well defined, we have reviewed the four main human bartonelloses and have examined unclear points about these emergent diseases

Cutaneous bacillary angiomatosis.

Bacillary angiomatosis is characterized by unique vascular lesions caused by infection with a small Gram staining bacillus of the genus Bartonella. It usually occurs in immunocompromised persons but can also occur in immunocompetent persons. We report a case of cutaneous bacillary angiomatosis in a 5-year-old immunocompetent child. He had infected lesions on the lips, after an injury, which was followed by lesions over the knees, buttocks, near the ankles and the elbows. Diagnosis was proved on histology. The lesions cleared after administration of erythromycin for 3 months. It is well to be aware of this condition in the context of increasing prevalence of AIDS.

Angiomatosis bacilar / Bacillary angiomatosis

La angiomatosis bacilar (AB) es un proceso patológico caracterizado por la prolifración vascular secundaria a microorganismos del género Bartonella. Se ha asociado comúnmente con pacientes HIV positivos, pero también ha sido reportado en otros pacientes inmunodeprimidos y en un pequeño grupo de pacientes sin inmuno-supresión demostrada. Se caracteriza por lesiones cutáneas vasculares que pueden diseminarse sistémicamente. La angiomatosis bacilar es tratable y puede ser curada con tratamiento antibiótico

Angiomatosis bacilar diseminada / Angiomatosis disseminated bacilar

Se presenta el caso de un varón de 25 años de edad, con lesiones costrosas en región malar derecha y lesión en "punto de rubí" en arco superciliar derecho. Los hallazgos histopatológicos en ambas biopsias fueron los de una proliferación vascular nodular, con presencia de infiltrado intersticial, focos de necrosis, edema, extravasación de hematíes y presencia de masas anfófilas de un material granular intersticial mucho más prominente en el ganglio linfático que en la piel. El material granular estaba constituido por conglomerados de estructuras bacilares. Se presentan las características histopatológicas que permiten realizar el diagnóstico diferencial de la angiomatosis bacilar con otras proliferaciones vasculares, siendo la principal diferencia del material intersticial eosinófilo o anfófilo descrito.

Bacillary angiomatosis: microbiology, histopathology, clinical presentation, diagnosis and management

Bacillary angiomatosis is known to be caused by a rickettsial organism; Rochalimaea henselae. This causative agent has been compared with different microorganisms and clinical conditions that appear in similar settings but that have been clearly differentiated from them; e.i. Cat-scratch disease (Afipia felis), Bartonella bacilliformis, other Rochalimaea sp., Kaposi;s sarcoma, Lobular capillary hemangioma, Angiosarcoma, and Epithelioid hemangioma. Clinically the bacillary angiomatosis (BA) skin lesions vary from a single lesion to thousands. The cutaneous lesion appears as a bright-red round papule, subcutaneous nodule, or as a cellulitic plaque. When the lesion is biopsied it tends to blanch-out, bleed, and cause pain. The patient might present with signs and symptoms of chills, headaches, fever, malaise, and anorexia with or without weight loss. The extracutaneous lesions found in BA tend to be from multiple organs affecting from the oral lesions to anal mucosal lesions to widespread visceral lesions. The sites of preferences for BA lesion manifestation tend to be the liver, spleen, lymph nodes, and bone. To diagnose bacillary angiomatosis the physician should prepare a differential diagnosis based primarily on its histopathological and clinical characteristics. To confirm the results from the stain, electron microscopy can identify the bacillus and pin-point the diagnosis of bacillary angiomatosis. The lesions presented by BA respond well to therapy with erythromycin 500mg four times daily for a duration of 2 weeks to 2 months. In case of intolerance to erythromycin the second line of drug that successfully treats the BA bacillus is doxycycline. If relapses of the BA lesion recur, then a prolonged antibiotic therapy is necessary and in AIDS patients the duration may be extended as life-long suppressive therapy

Bacillary angiomatosis: microbiology, histopathology, clinical presentation, diagnosis and management

Bacillary angiomatosis is known to be caused by a rickettsial organism; Rochalimaea henselae. This causative agent has been compared with different microorganisms and clinical conditions that appear in similar settings buy have been clearly differentiated from them; e.i. Cat-scratch disease (Afipia felis), Bartonella bacilliformis, other Rochalimaea sp., Kaposi's sarcoma, Lobular capillary hemangioma, Angiosarcoma, and Epithelioid hemangioma. Clinically the bacillary angiomatosis (BA) skin lesions vary from a single lesion to thousands. The cutaneous lesion appears as a bright-red round papule, subcutaneous nodule, or as a cellulitic plaque. When the lesion is biopsied it tends to blanch-out, bleed, and cause pain. The patient might present with signs and symptoms of chills, headaches, fever, malaise, and anorexia with or without weight loss. The extracutaneous lesions found in BA tend to be from multiple organs affecting from the oral lesions to anal mucosal lesions to widespread visceral lesions. The sites of preference for BA lesion manifestation tend to be the liver, spleen, lymph nodes, and bone. To diagnose bacillary angiomatosis the physician should prepare a differential diagnosis based primarily on its histopathological and clinical characteristics. To confirm the results from the stain, electron microscopy can identify the bacillus and pin-point the diagnosis of bacillary angiomatosis. The lesions presented by BA respond well to therapy with erythromycin 500 mg four times daily for a duration of 2 weeks to 2 months. In case of intolerance to erythromycin the second line of drug that successfully treats the BA bacillus is doxycyline. If relapses of the BA lesion recur, then a prolonged antibiotic therapy is necessary and in AIDS patients the duration may be extended as life-long suppressive therapy

Angiomatosis bacilar y peliosis bacilar en pacientes infectados con el virus de la inmunodeficiencia humana / Bacillary angiomatosis and bacillary peliosis in patients infected with Human Inmunodeficiency Virus

Los Dres. Koehler y Tappero han estudiado ampliamente el problema de la infección por Rochalimaea en las personas infectadas con el virus de la inmunodeficiencia humana tipo 1 (HIV-1). Especies de este género provocan enfermedades como la fiebre de las trincheras y la enfermedad por arañazo de gato; en la actualidad también están siendo identificados como agentes etiológicos de enfermedad cutánea, visceral, ósea y de bacteriemias en los individuos infectados con el HIV-1. La principal consideración a tener en cuenta en el diagnóstico diferencial de las personas infectadas por HIV-1, está dada por el Sarcoma de Kaposi. Estos autores brindan un enfoque útil para arribar al diagnóstico y dan pautas sobre el tratamiento antibiótico de esta complicación infecciosa que acompaña a la inmunosupresión que es relativamente poco frecuente. Es importante reconocer esta infección, dado que sólo parece responder a una terapia antibiótica prolongada (que posiblemente se extienda durante toda la vida)