Bacillary angiomatosis with atypical clinical presentation in an immunocompetent patient

Abstract

Bacillary angiomatosis is a recently described infectious disease that usually affects immunosupressed hosts with a previous history of contact with cats. We report a rare case of bacillary angiomatosis in an immunocompetent 59-year-old woman with no history of previous exposure to cats, and atypical clinical features (fever and subcutaneous nodules with ulceration on the left ankle). Histopathology of the lesion showed extensive ulceration and reactive tumor-like vascular proliferation of the blood vessels with swollen endothelial cells and an inflammatory infiltrate including neutrophils and lymphocytes in the dermis and subcutis. Staining with the Warthin-Starry method demonstrated the presence of clustered bacilli located in the extracellular matrix adjacent to the proliferating endothelial cells. Diagnosis was confirmed with the detection of Bartonella spp. DNA in the affected skin and in bone marrow using polymerase chain reaction.

Bacillary angiomatosis in an immunocompetent individual

“…It is now well-documented that human infections occur either by direct contact with cats or has a history of recent licking, scratching, or biting by a cat, it can also spread by an arthropod vector. [ 2 ] In this present case, patient definitely recalled a strong positive history of contact with domestic cat before the onset of her lesions (recent scratching).…”

“…Bartonellaquintana and Bartonellahenselae organisms are associated with BA. [ 2 ] Bartonella is the only genus of bacteria that is capable of producing cutaneous angioproliferation as is evident from clinical presentation in cases of verruca perunana and BA. [ 3 ] The incubation period ranges from 10 days to 210 days with average being 60 days.…”

Bacillary angiomatosis in immunocompetent patient with atypical manifestations

“…There are only a few case reports about BA in immunocompetent individuals. [ 3 4 5 6 7 ] Our patient in this report was immunocompetent without any history of recurrent infections or usage of immunosuppressive drugs, leukemia or lymphoma. One third of the patients with BA have no known exposure to cats, suggesting that BA may also be acquired by other ways besides direct contact with these animals.…”

A systematic review on antibiotic therapy of cutaneous bacillary angiomatosis not related to major immunocompromising conditions: from pathogenesis to treatment

“…have been detected in both wild animals and pets, few data have been published regarding transmission of these bacteria in pets and wild animals and the possible pathogenicity for these hosts [ 4 – 7 ]. The most studied species in human pathology are B. henselae, B. bacilliformis and B. quintana [ 8 ]. B. bacilliformis is responsible of Carrion’s disease, which stands among the array of neglected tropical diseases, often overlooked despite its significant impact on affected communities.…”