A 51-year-old human immunodeficiency virus (HIV)-positive male patient (CDC stage 3C) had had a painful nodule on his external ankle joint for 10 months. A biopsy suggested bacillary angiomatosis, but Kaposi's sarcoma could not be excluded. Rods were detectable in lesional skin by a Warthin-Starry stain. A 298 base pair (bp) gene fragment specific for Bartonella species was amplified from lesional skin and direct nucleotide sequence analysis of the amplification product clearly identified Bartonella quintana. Kaposi's sarcoma-associated herpes virus specific DNA was not amplifiable by polymerase chain reaction (PCR) in our patient, suggesting that the lesion represented bacillary angiomatosis alone, despite clinical and histopathological features which suggested the coexistence of bacillary angiomatosis and Kaposi's sarcoma. The lesion regressed after erythromycin was prescribed. However, 4 and 9 weeks after initiation of therapy, PCR still yielded a positive result in material obtained by a swab. After complete healing, following 12 weeks of antibiotic therapy, PCR became consistently negative. The optimal length of antibiotic treatment in HIV-positive patients with bacillary angiomatosis is not yet known and inadequate therapy may be followed by disseminated disease and a fatal outcome. PCR-based monitoring of the success of treatment is valuable for determining the duration of treatment resulting in a cure.

译文

一名51岁的人类免疫缺陷病毒 (HIV) 阳性男性患者 (CDC阶段3C) 的外踝关节结节疼痛10个月。活检提示细菌性血管瘤病,但不能排除卡波西氏肉瘤。通过Warthin-Starry染色在病变皮肤中可检测到杆。从病变皮肤扩增出针对巴尔通体物种的298碱基对 (bp) 基因片段,并对扩增产物的直接核苷酸序列分析清楚地鉴定出了巴尔通体。在我们的患者中,与卡波西氏肉瘤相关的疱疹病毒特异性DNA无法通过聚合酶链反应 (PCR) 扩增,这表明该病变仅代表细菌性血管瘤病,尽管临床和组织病理学特征表明细菌性血管瘤病和卡波西氏肉瘤并存。开药红霉素后病变消退。然而,在开始治疗后4周和9周,PCR仍在拭子获得的材料中产生阳性结果。完全愈合后,经过12周的抗生素治疗,PCR始终呈阴性。对于HIV阳性的细菌性血管瘤病患者,抗生素治疗的最佳时间尚不清楚,治疗不足可能会导致传播性疾病和致命后果。基于PCR的治疗成功监测对于确定导致治愈的治疗持续时间很有价值。

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