   |
|
CORRESPONDENCE |
|
| Year : 2022 | Volume
: 67
| Issue : 6 | Page : 814-815 |
|
| Bacillary angiomatosis involving tongue in a patient with myelofibrosis |
|
|
Pradeep Balasubramanian
Department of Dermatology, Zoram Medical College, Mizoram, India
| Date of Web Publication | 23-Feb-2023 |
Correspondence Address:
Pradeep Balasubramanian
Department of Dermatology, Zoram Medical College, Mizoram
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.ijd_819_22
|
|
How to cite this article:
Balasubramanian P. Bacillary angiomatosis involving tongue in a patient with myelofibrosis. Indian J Dermatol 2022;67:814-5 |
Sir,
Bacillary angiomatosis (BA) is a vaso-proliferative infectious disease caused by the gram-negative organism Bartonella henselae and quintana. The infection manifests mostly in immunocompromised individuals.[1] I report a case of BA involving the tongue in a patient with myelofibrosis.
A 55-year gentleman presented with reddish polypoidal nodules on his tongue which bleeds easily. He is a known case of myelodysplastic syndrome with myelofibrosis and marked pancytopenia proven by bone marrow biopsy. On examination, there were three vascular, friable nodules on lateral borders of tongue (2 on right side and one on left side) [Figure 1] and [Figure 2]. He is an agriculturist and rears cats and dogs in his home. BA and Kaposi sarcoma were the differential diagnoses considered. | Figure 1: Vascular, friable nodules on lateral borders of tongue (2 on right side)
Click here to view |
 | Figure 2: Vascular, friable nodules on lateral borders of tongue (one on left side)
Click here to view |
Histopathology of the lesion showed proliferation of vascular channels [Figure 3]. Immunoglobulin (Ig)M Bartonella henselae antibodies turned out positive on performing enzyme immunoassay (EIA). The patient was started on tablet erythromycin 500 mg QID. The lesions resolved completely in a week as evident in the picture [Figure 4] and [Figure 5]. Erythromycin was continued for 2 months and then stopped. The patient is currently under remission at the end of 3 months follow-up. | Figure 3: Histopathology of a lesion depicting proliferation of vascular channels
Click here to view |
 | Figure 4: Resolution of the lesions 1 week post initiation of oral erythromycin
Click here to view |
 | Figure 5: Resolution of the lesions 1 week post initiation of oral erythromycin
Click here to view |
BA was first reported in 1983 in a human immunodeficiency virus (HIV) infected patient following which it was reported in several immunocompromised patients.[1] There are occasional reports of BA in immunocompetent individuals too.[2] BA is caused by B. henselae or B. quintana. Domestic cats serve as the main reservoir of B. henselae. It spreads to human through cat sratch, bite or by cat flea. Humans are the only reservoir for B. quintana. The body louse Pediculus humanus transmits B. quintana to humans. The unique property of Bartonella in causing vaso-proliferation is accomplished by its ability to induce the endothelial cells to produce angiopoietin-2 and epithelial cells to produce vascular endothelial growth factor (VEGF).
Solitary or multiple, red or purple papule or nodule which are sessile or pedunculated are certain forms of presentation. The lesions can ulcerate at times. The cutaneous lesions are commonly seen in upper limbs and can occur at any site. Multiple lesions can occur as crops occasionally.[2] Pyogenic granuloma-like nodule at the site of cat scratch or bite in immunocompetent individuals is also reported.[3] The lesions are few in organ transplant recipients in comparison to HIV-infected.[4] Cutaneous and subcutaneous lesions are the common ones followed by the involvement of mucosa, liver, spleen, lymph nodes and bones.
The differential diagnoses include pyogenic granuloma, Kaposi sarcoma and verruga peruana (caused by Bartonella Bacilliformis which is endemic to certain areas of South America). The laboratory methods of diagnosing the disease is by histopathology with Warthin–Starry silver stain, polymerase chain reaction (PCR), culture and antibody assay. Warthin–Starry stain was not performed in this patient due to non-availability.
The treatment of choice is erythromycin or doxycycline. For those who cannot tolerate these antibiotics, azithromycin or clindamycin can be administered.[5]
We report this case to spread awareness about this rare opportunistic zoonotic infection in an uncommon location (tongue in present case) which can be easily treated if identified earlier.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
 References | |  |
| 1. | Stoler MH, Bonfiglio TA, Steigbigel RT, Pereira M. An atypical subcutaneous infection associated with acquired immune deficiency syndrome. Am J Clin Pathol 1983;80:714-8.  |
| 2. | Ramírez Ramírez CR, Saavedra S, Ramírez Ronda C. Bacillary angiomatosis: Microbiology, histopathology, clinical presentation, diagnosis and management. Bol Asoc Med P R 1995;87:140-6. |
| 3. | Albayrak A, Albayrak Y, Unal D, Atasoy M, Uyanik MH. A case of bacillary angiomatosis developed at a burn site. Indian J Dermatol Venereol Leprol 2012;78:121. [ PUBMED] [Full text] |
| 4. | Moulin C, Kanitakis J, Ranchin B, Chauvet C, Gillet Y, Morelon E, Euvrard S. Cutaneous bacillary angiomatosis in renal transplant recipients: Report of three new cases and literature review. Transpl Infect Dis 2012;14:403-9. |
| 5. | Rodriguez O, Campbell LR, Bacha JM, Kovarik CL. Successful treatment of bacillary angiomatosis with oral doxycycline in an HIV-infected child with skin lesions mimicking Kaposi sarcoma. JAAD Case Rep 2016;2:77-9. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5] |
|
|
|
|
|
|
|
|
