Angiomatose Bacilar em Doente Imunocompetente

A Propósito de um Caso Clínico

 

Ana Luísa Faria, Ricardo Carvalho, Nuno Lima, Rui Castanheira

Serviço de Medicina Interna B, Hospital de São João, Porto

 

Angiomatose bacilar é uma doença recentemente descrita, caracterizada por lesões na pele, vísceras ou em ambas. Embora inicialmente associada à infecção pelo vírus da imunodeficiência humana (VIH), a Angiomatose bacilar tam bém tem sido descrita em doentes imunodeficientes não infectados pelo VIH e em doentes imunocompetentes. Bartonella é a bactéria considerada responsável pela Angiomatose bacilar e a maior parte destes doentes responde bem à antibioterapia. Relata-se um caso clínico de um doente imunocompetente, com história de contacto com gato, que apresentava várias lesões cutâneas dispersas pelo corpo. A TC abdominal mostrou adenopatias intra-abdominais, o exame histológico da biópsia cutânea revelou apenas um infiltrado mononuclear e a pesquisa por PCR (Polimerase-Chain-Reaction) de ADN de Bartonella spp. foi positiva na lesão cutânea biopsada e no sangue. O doente foi tratado com doxiciclina durante três meses, com resposta completa.

Palavras-chave: angiomatose bacilar; Bartonella henselae; Bartonella quintana; coloração Warthin-Starry.

 

Bacillary Angiomatosis in a Immunocompetent Patient

Bacillary Angiomatosis is a recently described disease characterized by vascular lesions of skin, viscera or both. Although primarily associated with human immunodeficiency virus (HIV) infection, Bacillary Angiomatosis has been described in non-HIV immunosuppressed and immunocompetent patients as well. Bartonella have been found to be responsible for Bacillary Angiomatosis and most cases respond readily to antimicrobial therapy. This is a clinic case of an immunocompetent patient with a history of cat contact who presented with many widespread cutaneous lesions. Abdominal CT revealed intraabdominal lymphadenopathies, histopathology of cutaneous biopsy only revealed mononuclear infiltrate and DNA analysis by PCR (Polimerase-Chain-Reaction) for Bartonell spp. in cutaneous biopsy and in blood were positive. The patient was treated with doxycycline for three months, with complete resolution.

Key-words: bacillary angiomatosis; Bartonella henselae; Bartonella quintana; Warthin-Starry stain.

 

 

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Correspondência:

Dr.ª Ana Luísa Faria

Serviço de Medicina B

Hospital São João

Alameda Prof. Hernâni Monteiro 4200-319 Porto

e-mail: aluisafaria@hotmail.com