Indiana University Infectious Diseases Fellowship
31 Jan,
10 tweets, 6 min read
#idboardreview 35 M PLWH CD4 10, VL >200k presents w/ fever and myalgias x 1mo. CT w/ hypodense lesions, biopsy with 'blood lake'. Warthin-Starry stain+ diagnosis? #idmedEd #medEd #IDtwitter 
hepatosplenic #bacillary #peliosis #bartonella #henselae “blood lake” due to vascular dilation mixed with focal bleeding, numerous bacilli on WS stain or immunostaining
#Peliosis #hepatis rare condition characterized by tumor-like liver lesions composed of multiple blood-filled cavities. Associated with cytotoxic drug, gamma-ray, bacterial or viral infection, immunodeficiency etc
#Bacillary #peliosis #hepatis, a vascular lesion of the liver associated with infiltration of #Bartonella bacilli,1st described in eight HIV-infected individuals by Perkocha. Presents w/ abdominal pain and fever.
25% patients with #peliosis #hepatis also have cutaneous #bacillary lesions. Serum AlkP more prominently elevated than the hepatic transaminases
Treatment is with erythromycin or doxycycline for 3 months or longer/life long.
in vitro active against #Bartonella but w/ no established clinical efficacy: rifampin, 3rd gen cephalosporins, tmp-smx, FQ. Results of in vitro susceptibility tests dont correlate w/ clinically as tx failures w/penicillins/1st gen cephalosporins common
Relapsing patients should receive lifelong treatment. Jarisch-Herxheimer–like reactions have been reported following the first dose of antibiotics in patients with #Bartonella #peliosis #hepatis.
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