Male patient, 38 years old, with a history of alcoholism and polydrug use, mood disorder and hepatitis B diagnosed in 2005.
fever a. Infectious disease in February 2011 due to painful erythematous-violaceous tumors, progressive growth of 6 months of evolution, associated with general malaise and weight loss of 10 kg of two months
The patient was initially diagnosed with Kaposi's sarcoma (KS) and an HIV ELISA was requested, which was positive and confirmed by the Chilean Public Health Institute.
Given the extent of skin lesions and the presence of fever, the patient was hospitalized for further study.
On physical examination at admission, the patient was in regular general condition, hypotensive, febrile, and responsive (body mass index 17), with indurated inguinal lymphadenopathies, painless and little.
The patient presented erythematous-violaceous tumors up to 5 cm in diameter at the supra right level, located in men and in the left side.
Face, palate, trunk and extremities showed multiple erythematous papules and subcutaneous painful nodules without color changes.
No visceromegaly was investigated.
Of the general tests highlighted: haematocrit 28.3%; leukocytes 6,200 had elevated viral RNA < 7.63 mm3, without left shift; HSV 100 mm/h; PCR 9.1 (NV < 1); normal kidney function tests alkaline
Hemocultive, urocultive, RPR, PPD and IgG serology for toxoplasma were negative.
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When the clinical picture was reevaluated, the diagnosis of BA was proposed.
When asked directly the patient referred three trips abroad: Bolivia five years ago, Peru and Mexico three years ago.
He also lived two years ago in a house with cats, which occasionally scratched him.
Bartonella henselae serology was negative.
Nasofibroscopy revealed angiomatous lesions in the nasal cavity, nasopharynx and larynx.
Upper endoscopy did not detect lesions.
The computerized axial tomography showed normal, mild stenosis enlarged, left inguinal lymphadenopathies of secondary aspect liver nodule.
Doppler ultrasound of the upper and lower extremities showed nonspecific hypervascularized nodules in the dermis, subcutaneous tissue and muscle plane.
Biopsy of cutaneous lesions showed orthokeratosis, mild hypogranulosis, erythrocytosis, exocytosis of lymphocytes and basal hyperpigmentation; reticular dermis with prominent nodular vascular proliferation, multifocal endocytic infiltrate.
In addition, eosinophil, extracellular, granular, multifocal accumulations were observed.
Warthin-Starry staining showed numerous bacilli, and the findings were compatible with BA.
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A tissue sample was sent to the microbiology laboratory of the Catholic University to perform universal PCR with amplification and subsequent sequencing of the gene encoding the 16S ribosomal subunit.
DNA extraction from subcutaneous tissue was performed using a commercial method (QIAamp Tissue kit, Qiagen®), according to manufacturer's recommendations.
The amplification of the gene encoding the 16S rRNA gene was performed with universal primers.
Subsequently, the amplified product was sequenced and evaluated in the ABI-310 analyzer (Appropriated-Biosystems, Foster City, CA).
The BLAST program was used for comparison of sequences deposited in Genebank gene bank.
A 100% homology was found over 421 base pairs deposited with B. quintana strain Tose.
Antiretroviral treatment for HIV and prophylaxis for cystis jiroveci were initiated.
Treatment of BA was initiated with 500 mg/ day A and 500 mg q12h ciprofloxacin.
The patient presented a favorable evolution, with progressive regression of systemic symptoms and skin lesions in a few days.
