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. 2013:2013:694765.
doi: 10.1155/2013/694765. Epub 2013 Apr 28.

Bacillary Angiomatosis and Bacteremia due to Bartonella quintana in a Patient with Chronic Lymphocytic Leukemia

Rosamaria Fulchini  1 , Guido Bloemberg, Katia Boggian
Affiliations

Bacillary Angiomatosis and Bacteremia due to Bartonella quintana in a Patient with Chronic Lymphocytic Leukemia

Rosamaria Fulchini et al. Case Rep Infect Dis. 2013.

Abstract

We present a 63-year-old man treated with alemtuzumab for chronic lymphocytic leukemia who developed multiple angiomatous papules and fever. Real-time polymerase chain reaction (RT-PCR) from a skin lesion and blood sample revealed Bartonella quintana as causative agent confirming the diagnosis of bacillary angiomatosis with bacteremia. Treatment with doxycycline, initially in combination with gentamicin, led to complete resolution of the lesions. This case shows the importance of considering bacillary angiomatosis as a rare differential diagnosis of angiomatous lesions in the immunocompromised patient, particularly in chronic lymphocytic leukemia and following lymphocyte depleting treatments as alemtuzumab.

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Figures

Figure 1
Figure 1
Multiple vascular nodules and papules.
Figure 2
Figure 2
Angioma-like lesions with surrounding erythematous halo.
Figure 3
Figure 3
Polypoid granuloma pyogenicum-like lesion with ectatic, lobular vascular proliferation (hematoxylin-eosinstaining, 10×).
Figure 4
Figure 4
Mixed-cell infiltrates, predominantly granulocytes (hematoxylin-eosinstaining, 40×).
Figure 5
Figure 5
Bartonella quintana specific RT-PCR analysis of DNA extracts of skin biopsy (a) and blood (b).
See this image and copyright information in PMC

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