Bartonella quintana Infection Manifesting as Leucocytoclastic Vasculitis Rash

Brian J Hopkins; Bonnie C Prokesch

doi:10.1093/ofid/ofab333

Bartonella quintana Infection Manifesting as Leucocytoclastic Vasculitis Rash

Open Forum Infect Dis. 2021 Jul 6;8(7):ofab333. doi: 10.1093/ofid/ofab333. eCollection 2021 Jul.

Authors

Brian J Hopkins¹, Bonnie C Prokesch^{1

2}

Affiliations

¹ Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
² Medical Director of Antimicrobial Stewardship, Parkland Health and Hospital System, Dallas, Texas, USA.

Abstract

We present the first case described in the literature of leucocytoclastic vasculitis due to Bartonella quintana infection. A 73-year-old woman presented to the hospital with persistent fevers, retro-orbital headache, generalized weakness, and left lower thigh pain for 1 week. She was found to have truncal and proximal lower extremity papules and small plaques. Serology revealed Bartonella quintana immunoglobulin M (IgM) titer of 1:256 with undetectable Bartonella quintana immunoglobulin G (IgG) and undetectable Bartonella henselae IgG and IgM. Skin biopsy of an abdominal lesion revealed fibrinoid necrosis of vessel walls in the superficial and mid-dermis consistent with leucocytoclastic vasculitis. Doxycycline 100 mg orally twice daily was initiated, after which she had defervescence within 36 hours and rapid improvement of other presenting symptoms.

Keywords: bartonella; rash; vasculitis.

Publication types

Case Reports