Bacillary angiomatosis with bone invasion

Abstract Bacillary angiomatosis is an infection determined by Bartonella henselae and B. quintana, rare and prevalent in patients with acquired immunodeficiency syndrome. We describe a case of a patient with AIDS and TCD4+ cells equal to 9/mm3, showing reddish-violet papular and nodular lesions, disseminated over the skin, most on the back of the right hand and third finger, with osteolysis of the distal phalanx observed by radiography. The findings of vascular proliferation with presence of bacilli, on the histopathological examination of the skin and bone lesions, led to the diagnosis of bacillary angiomatosis. Corroborating the literature, in the present case the infection affected a young man (29 years old) with advanced immunosuppression and clinical and histological lesions compatible with the diagnosis.

Angiomatosis bacilar por Bartonella quintana como primera manifestación de infección por VIH: Report of one case / Bacillary angiomatosis

Background: Bacillary angiomatosis is an unusual infectious disease, with angioproliferative lesions, typical of immunocompromised patients. It is caused by Bartonella quintana and Bartonella henselae, two infectious agents of the genus Bartonella, which trigger variable clinical manifestations, including cutaneous vascular and purpuric lesions, and regional lymphadenopathy, and even a systemic disease with visceral involvement. We report a 38-year-old HIV positive male presenting with a history of six months of cutaneous growing purple angiomatous lesions, located also in nasal fossae, rhi-nopharynx and larynx. The skin biopsy was compatible with bacillary angiomatosis. Polymerase chain reaction of a tissue sample showed homology with B. quintana strain Toulouse. The patient was treated with azithromycin and ciprofloxacin with a favorable evolution.

Angiomatosis bacilar: resolución espontánea? / Bacillary angiomatosis: spontaneous resolutión?

La angiomatosis bacilar es una enfermedad infecciosa oportunista con manifestaciones sistémicas, no conocidas antes de la epidemia del virus de la inmunodeficiencia humana (HIV). Se manifiesta usualmente en pacientes inmunodeprimidos con recuentos de linfocitos T CD4+ inferiores a 200 células /µL y su evolución, sin tratamiento, cuenta con elevados índices de mortalidad. Presentamos un paciente de sexo masculino, de 27 años, con antecedentes de SIDA, que había iniciado HAART 18 días antes de su derivación a nuestro servicio. Al examen físico se observaban lesiones generalizadas de 1 mes de evolución, compatibles clínica e histológicamente con angiomatosis bacilar, que resolvieron en forma espontánea en 4 semanas.

Bacillary angiomatosis: description of 13 cases reported in five reference centers for AIDS treatment in Rio de Janeiro, Brazil

The aim of this case series was to describe the clinical, laboratory and epidemiological characteristics and the presentation of bacillary angiomatosis cases (and/or parenchymal bacillary peliosis) that were identified in five public hospitals of Rio de Janeiro state between 1990 and 1997; these cases were compared with those previously described in the medical literature. Thirteen case-patients were enrolled in the study; the median age was 39 years and all patients were male. All patients were human immunodeficiency virus type 1 (HIV-1) infected and they had previous or concomitant HIV-associated opportunistic infections or malignancies diagnosed at the time bacillary angiomatosis was diagnosed. Median T4 helper lymphocyte counts of patients was 96 cells per mmÝ. Cutaneous involvement was the most common clinical manifestation of bacillary angiomatosis in this study. Clinical remission following appropriate treatment was more common in our case series than that reported in the medical literature, while the incidence of relapse was similar. The frequency of bacillary angiomatosis in HIV patients calculated from two of the hospitals included in our study was 1.42 cases per 1000 patients, similar to the frequencies reported in the medical literature. Bacillary angiomatosis is an unusual opportunistic pathogen in our setting

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.

Angiomatose bacilar em paciente com lúpus eritematoso sistêmico / Bacillary angiomatosis in a patient with systemic lupus erythematosus

É descrito um caso de angiomatose bacilar em um doente com lúpus eritematoso sistêmico. A angiomatose bacilar é freqüente nos doentes imunodeprimidos. Pode afetar diversos órgäos, mas no presente caso, as lesöes eram predominantemente nódulos dérmicos e subcutâneos, alguns recobertos por pele normal e outros com aspecto angiomatoso. Pelo estudo imunoistoquímico identificou-se a Bartonella quintana, apesar de que a Bartonella henselea é mais frequente. A cura foi obtida pela administraçäo de eritromicina 2 g/dia por quatro semanas.

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)