Case Report

Infection

, 35:107

First online:

Chronic Vasculitis and Polyneuropathy due to Infection with Bartonella henselae

  • B. StockmeyerAffiliated withDept. of Medicine III, University Hospital Erlangen
  • , C. SchoernerAffiliated withInstitute of Clinical Microbiology, Immunology and Hygiene, University of Erlangen-Nuremberg
  • , P. FrangouAffiliated withInstitute for Pathology, University of Erlangen-Nuremberg
  • , T. MoriabadiAffiliated withDept. of Neurology, University Hospital Erlangen
  • , D. HeussAffiliated withDept. of Neurology, University Hospital Erlangen
  • , T. HarrerAffiliated withDept. of Medicine III, University Hospital Erlangen Email author 

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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.