RESUMO
Se presenta un paciente con enfermedad VIH/SIDA avanzada, que desarrolló un cuadro de angiomatosis bacilar por Bartonella henselae, con manifestaciones cutáneas, mucosas, sistémicas y que respondió favorablemente al tratamiento con antibióticos más la terapia antirretroviral.
We report a case of a patient with advanced HIV/AIDS disease who developed a bacillary angiomatosis due to Bartonella henselae with cutaneous, mucosae, systemic compromise and a good response to the antimicrobial therapy plus highly active antiretroviral therapy.
RESUMO
Se presenta un paciente con enfermedad VIH/SIDA avanzada, que desarrolló un cuadro de angiomatosis bacilar por Bartonella henselae, con manifestaciones cutáneas, mucosas, sistémicas y que respondió favorablemente al tratamiento con antibióticos más la terapia antirretroviral.(AU)
We report a case of a patient with advanced HIV/AIDS disease who developed a bacillary angiomatosis due to Bartonella henselae with cutaneous, mucosae, systemic compromise and a good response to the antimicrobial therapy plus highly active antiretroviral therapy.(AU)
RESUMO
We report the first case of bacillary angiomatosis due to Bartonella quintana affecting a Chilean a HIV positive patient in Chile. He was a 27 years old, heterosexual male, indigentman known to be HIV positive serological status known from September, 2003, under irregular medical control. On April, 2005, he presented a progressive abscess in the frontal region and erythematous papules in the extremities, that extended to face, thorax and mucoses, becoming nodular and violaceous lesions. Bacillary angiomatosis diagnosis was initially sustained on account of the clinical manifestations, and was confirmed by serology and Warthin Starry staining from a skin biopsy. The etiological agent was identified as Bartonella quintana through universal RPC performed from a cutaneous nodule to detect 16S rRNA gen. Azithromycin plus ciprofloxacin was started, besides of anti retroviral therapy antiretroviral, with the lesions being progressively disappearing.
Reportamos el primer caso de angiomatosis bacilar por Bartonella quintana en un paciente con infección por VIH en nuestro país. Este corresponde a un hombre de 27 años, heterosexual, indigente, seropositivo para VIH conocido desde septiembre de 2003, en control irregular. En abril de 2005, el paciente desarrolló un aumento progresivo de volumen en la región frontal y aparición de pápulas eritematosas en las extremidades, que luego se extendieron a la cara, tórax y mucosas, tornándose nodulares y violáceas. El diagnóstico de angiomatosis bacilar se planteó inicialmente por el cuadro clínico del paciente, siendo confirmado por serología y tinción de Warthin Starry positiva en la biopsia de piel. El agente causal se identificó como Bartonella quintana por RPC universal para el gen del 16S ARNr de un nódulo cutáneo. Se inició terapia antimicrobiana con azitromicina y ciprofloxacina, además de terapia antiretroviral, con desaparición de las lesiones en forma progresiva.
Assuntos
Adulto , Humanos , Masculino , Angiomatose Bacilar/diagnóstico , Bartonella quintana/isolamento & purificação , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/terapia , Angiomatose Bacilar/terapiaRESUMO
A bartonela causa a Doença da arranhadura do gato, mas em imunossuprimidos pode levar à doença sistêmica, denominada angiomatose bacilar.Descrição do caso: Masculino, 15 anos, transplantado há 3 anos, em uso de FK, MMF e prednisona com função renal preservada. Refere tumoraçãoavermelhada e dolorosa na região mandibular esquerda há 30 dias, com febre elevada há 7 dias. Esta em regular estado geral, descorado, 39ºC, commassa submandibular de 4cm de diâmetro, consistência carnosa com vesículas na superfície e hepato-esplenomegalia. Bx da massa compatível com Angiomatose Bacilar. Evoluiu bem com Cloranfenicol e Eritromicina. Apresentou elevação da creatinina sérica, sendo feita hipótese de rejeição e realizadopulso de metilprednisolona com normalização da função renal. Conclusões: Como a soroprevalência de Bartonela, em gatos, é elevada em nosso meio, deve-se estar alerta para seu diagnóstico. Pacientes imunossuprimidos podem apresentar formas sistêmicas graves de infecções comuns que, pelararidade, podem ser diagnosticadas tardiamente e carrear maior morbidade.
Bartonela sp causes cat scratch disease but in immunosuppressed hosts it can be associated with a systemic disease named bacillary angiomatosis.Description of case: A 15-year old boy with a successful kidney transplant for 3 years had been treated with FK, MMF and prednisone. He reported ared and painful mass in the left submandibular area for 30 days, and high fever for the last 7 days. He looked sick, pale and had a submandibular mass of 4cm in diameter with vesicles in its surface and hepatosplenomegaly. Biopsy of the mass was suggestive of bacillary angiomatosis. He was treated withchloramphenicol and erythromycin and had a favorable course. An increase of creatinine, interpreted as rejection, was successfully managed with a pulseof methylprednisolone. Conclusions: As the prevalence of bartonelosis in cats is elevated in our country, physicians should be aware of that diagnosticpossibility. Immunocompromised hosts may present rare systemic forms of common diseases that can be diagnosed late and produce sequels.