Cutaneous bacillary angiomatosis due toBartonella quintanain a renal transplant recipient

Abstract

Summary Bacillary angiomatosis (BA) is a disorder of neovascular proliferation involving skin and other organs of immunosuppressed patients caused by Bartonella species. BA has been recognized in both immunocompetent and immunodeficient patients, mostly in human immunodeficiency virus (HIV)‐infected persons, much more rare in those with other immunodeficiencies, including organ transplantation. Diagnosis is based on serologic analysis, culture and molecular biology [detection of Bartonella species deoxyribonucleic acid (DNA) in tissue biopsy extracts by real‐time polymerase chain reaction (PCR)]. All immunosuppressed patients with BA should be treated with antibiotics because of potentially life‐threatening course of the disease. We report the first case of cutaneous bacillary angiomatosis due to Bartonella quintana in renal transplant recipient. This presentation demonstrates that BA should be considered a differential diagnosis in immunocompromised patients presenting with fever and cutaneous angioma‐like lesions.

Bacillary angiomatosis triggered by severe trauma in a healthy Caucasian patient: A case report

“…Bacillary angiomatosis was first described several decades before in HIV-positive patients (13) as an opportunistic infection, but it may also occur in the context of other conditions that may impair the immune status, such as chronic lymphocytic leukemia (11,14,15), chemotherapy (16), systemic corticotherapy (17), solid organ transplantation (18)(19)(20), hepatitis B infection (3). Nevertheless, immunocompetent patients can be affected by this cutaneous disorder (6,17,(21)(22)(23)(24).…”

“…Fever, weight loss, anorexia, malaise and lymphadenopathy may be associated complaints (31). In case the abscesses invade the liver or the spleen, B. henselae can be the first culprit of this disease called 'bacillary peliosis' (4,19).…”

“…The histopathological description correlates with the clinical appearance of the lesions. When pyogenic granuloma-like lesions are seen, microscopy shows elements that are more superficially located, characterized by a lobular proliferation of small vascular structures (capillaries and venules) and plump endothelial cells, associated with an inflammatory infiltrate (with neutrophils, lymphocytes and histiocytes) (18,19,22,26). In other clinical forms, the cellular content is more dense and deeper (22,26).…”

“…The appropriate therapy is with oral erythromycin (500 mg x4/daily) and doxycycline (100 mg twice daily), but several treatments such as cephalosporins, penicillins, macrolides, aminoglycosides, rifampin, dapsone, ciprofloxacin, have been tried with favorable results (19,31,34,35).…”

Bartonellosis in Chronic Kidney Disease: An Unrecognized and Unsuspected Diagnosis

“…There was inadequate information in two cases. Diagnostic methods and other characteristics of renal allograft recipients with bartonellosis are expressed in Table 3 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30).…”