Bacillary Angiomatosis of Lymph Nodes: Unusual Case Presentation in an Immunocompetent Adolescent

Abstract

Bacillary angiomatosis is a neovascular proliferative condition caused by the Bartonella group of opportunistic bacteria, commonly occurring in patients with advanced Human Immunodeficiency Virus (HIV) and other immunocompromised conditions. However, cases have also been reported to occur rarely in immunocompetent individuals. Skin lesions such as nodules and papules are the most common manifestations, although cases have been rarely reported in other sites such as the oral cavity, respiratory tract, gastrointestinal tract, and bones. Isolated lymph node involvement or systemic manifestations such as fever, chills, anorexia, and weight loss are very rare. Since Bartonella is a fastidious Gram-negative bacterium that is difficult to grow and isolate in culture, diagnosis relies on histological examination of the affected organ/tissue and demonstration of the causative bacteria using special stains such as Warthin-Starry, Giemsa, Gram’s, and silver stains. Herein, the authors presented a case of bacillary angiomatosis in a 14-year-old immunocompetent adolescent male who presented with recurrent fever and painful enlargement of the axillary lymph nodes. The case is notable for its unusual clinical manifestations of systemic symptoms, specifically anorexia and significant weight loss, leading to suspicion of malignancy. Following the establishment of the diagnosis, the boy experienced complete recovery, with regained appetite and weight, following treatment with a long duration of antibiotics.