title: Chronic vasculitis and polyneuropathy due to infection with Bartonella henselae.
abstract: Bartonella henselae, the causative agent of cat scratch disease and bacillary angiomatosis, is associated with an expanding spectrum of diseases. Here, we report on a 40-year-old patient suffering from chronic recurrent painful ulcers of the toes, distal axonal sensomotor polyneuropathy and Raynaud's phenomenon. Biopsy of the sural nerve demonstrated an axonal neuropathy with a neurogenic muscular atrophy. Treatment with high dose corticosteroids had no beneficial effect. A biopsy taken from a recurring ulcer 7 years after the beginning of the disease revealed superficial ulcerated hyperkeratosis with subepithelial proliferation of small vessels compatible with a diagnosis of verruca peruana, however, without detection of microorganism. Serologic analysis revealed an elevated IFT titer of 1:1,024 against B. henselae. Treatment with erythromycin induced healing of the ulcer, remission of the vasculitis and the polyneuropathy, and a decline of the IFT titer. This case illustrates that B. henselae infection should be considered in patients with vasculitis and polyneuropathic syndromes.
authors.affiliation: Dept. of Medicine III, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany. Thomas.Harrer@med3.imed.uni-erlangen.de
authors.forename: B
authors.initials: B
authors.lastname: Stockmeyer
authors.forename: C
authors.initials: C
authors.lastname: Schoerner
authors.forename: P
authors.initials: P
authors.lastname: Frangou
authors.forename: T
authors.initials: T
authors.lastname: Moriabadi
authors.forename: D
authors.initials: D
authors.lastname: Heuss
authors.forename: T
authors.initials: T
authors.lastname: Harrer
mesh_terms: D000328:Adult; D016917:Angiomatosis, Bacillary / Q000150:complications*; D018416:Bartonella henselae / Q000302:isolation & purification; D002908:Chronic Disease; D016523:Foot Ulcer / Q000209:etiology; D006801:Humans; D008297:Male; D011115:Polyneuropathies / Q000209:etiology*; D012008:Recurrence; D014657:Vasculitis / Q000209:etiology*