title: Bacillary angiomatosis presenting with facial tumor and multiple abscesses: A case report.
abstract: BACKGROUND
  The clinical manifestation of bacillary angiomatosis (BA) can be limited to one organ, most commonly the skin, but systemic courses can also occur. We report a human immunodeficiency virus (HIV)-positive patient with a systemic manifestation of BA caused by Bartonella quintana, diagnosed in Vienna, Austria. The pathogen was detected in multiple organs including a facial tumor which is an unusual finding for BA. Furthermore, infections with B quintana are rare in our area and no other autochthonous cases have been reported.
  
  
  RESULTS
  The clinical manifestation included multiple papules and nodules on the entire body, several organic abscesses, and a facial tumor influencing the patient's view.The main laboratory finding indicated HIV infection combined with severe immunosuppression with 47 CD4 cells/μL. Contrast-enhanced computed tomography of the chest and the abdomen showed multiple and abscesses. Histological examination of the facial tumor confirmed inflammatory process. Bartonella quintana was detected by PCR in blood and in the facial tumor as well as by culture in the skin tissue. Antibiotic treatment with doxycycline and antiretroviral therapy resulted in clinical improvement.
  
  
  CONCLUSIONS
  Our case shows that rare opportunistic, vector-borne infections, usually associated with poverty, can lead to diagnosis of HIV even in well-developed countries. Furthermore, we provide details on clinical manifestation and diagnostic work-up which might expand the knowledge on disseminated infections with B quintana. As far, tumorous deformations have rarely been reported as consequence of BA. In our patient the pathogen was detected in the facial tumor using PCR techniques.
authors.affiliation: Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology Clinical Institute for Pathology Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Markowicz
authors.forename: Stephanie
authors.initials: S
authors.lastname: Käser
authors.forename: Andreas
authors.initials: A
authors.lastname: Müller
authors.forename: Gerold
authors.initials: G
authors.lastname: Lang
authors.forename: Susanna
authors.initials: S
authors.lastname: Lang
authors.forename: Marius
authors.initials: M
authors.lastname: Mayerhöfer
authors.forename: Gerold
authors.initials: G
authors.lastname: Stanek
authors.forename: Armin
authors.initials: A
authors.lastname: Rieger
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology*; D000038:Abscess / Q000382:microbiology*; D000328:Adult; D016917:Angiomatosis, Bacillary / Q000382:microbiology*; D001317:Austria; D018413:Bartonella quintana / Q000302:isolation & purification*; D003287:Contrast Media; D005145:Face; D015658:HIV Infections / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D016133:Polymerase Chain Reaction; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media