Received May 20, 1991 ; accepted after revision July 17, 1991. I All authors: Department of Radiology, New York lkiiversity Medical Center, Bellevue Hospital 3W37, 27th St. and First Ave., New York, NY 10016. AJR 157:1249-1251, December 1991 0361-803X/91/1576-1249© American Roentgen Ray Society 1249 Case Report . ‘v. Soft-Tissue and Osseous Lesions Caused by Bacillary Angiomatosis: Unusual Manifestations of Cat-Scratch Fever in Patients with AIDS Brian A. Herts,1 Mahvash Rafii,and Gary Spiegel Cat-scratch disease, caused by a pleomorphic Gram-neg- ative rod known as the cat-scratch bacillus, has many rare and varied complications and unusual manifestations [1]. Recent reports [2-6] have described bacillary angiomatosis as a new manifestation of systemic cat-scratch disease seen in patients with AIDS who have cutaneous lesions, subcuta- neous nodules, or osteolytic lesions. We report a case of bacillary angiomatosis that was manifested as a vascular soft- tissue mass in which cat-scratch bacilli were shown by elec- tron microscopy. To our knowledge, no similar cases of soft- tissue masses in systemic cat-scratch disease have been reported. As our case illustrates, systemic cat-scratch disease has clinical and radiologic features that resemble both benign and malignant diseases. Although certain radiologic and din- ical findings may suggest the diagnosis of systemic cat- scratch disease, a definitive diagnosis is made only on the basis of biopsy specimens examined by using either special stains or electron microscopy. Case Report A 42-year-old man with a history of IV drug use and bisexuality had had lower back pain for 6 days after an episode of mild trauma. He reported that he had fevers, night sweats, and generalized weak- ness. He also reported a “lump” in the left side of his chest wall that was occasionally painful and was first noticed about the time his fevers and night sweats began. His body temperature was 102.2#{176}F (39.0#{176}C). A mobile, soft, and nontender 4x5cm mass was palpated in the left side of the chest wall. Laboratory values on admission included an erythrocyte sedimentation rate of 90 mm/hr (normal, <1 5), a hemoglobin level of i 1.9 g/dl (i i 9 g/l), and a normal WBC count. The patient tested positive for antibodies to human immuno- deficiency virus (HIV). The mass in the chest wall showed enhancement on a contrast- enhanced CT(Fig. 1A)and abnormal uptake of radionuclide on gallium scintigraphy (Fig. 1B). An angiogram confirmed the vascular nature of the mass, which subsequently was resected for diagnosis; the provisional diagnosis was hemangiosarcoma. Initial evaluation of the patient’s lower back pain included radio- graphs, myelogram, and CT (after the myelogram) of the Iumbosacral spine; findings on all were interpreted as normal. Two weeks into the hospitalization, a bone scan obtained because of continued back pain showed abnormal uptake of radionuclide at L3. Radiographs and CT images of the lumbosacral spine at this time showed an osteolytic lesion ofthe L3 vertebral body (Fig. 1C) that was thought to represent a metastatic focus of hemangiosarcoma. Subsequent electron microscopic examination of the resected axillary mass showed benign vascular proliferation and multiple bacilli (Fig. 1 D). The bacilli were consistent with cat-scratch bacilli, and the diagnosis of bacillary angiomatosis was established. CT-guided bi- opsy of L3 was performed; however, only necrotic tissue was ob- tamed. The spinal lesion was thought to be due to disseminated cat- scratch disease, and the patient was treated with doxycycline. No recurrence of the axillary soft-tissue mass was seen, and follow-up CT of the L3 lesion showed partial resolution and sclerosis of the lesion consistent with healing. Retrospectively, the patient did not recall any exposure to cats. Downloaded from www.ajronline.org by 171.243.65.178 on 05/15/23 from IP address 171.243.65.178. Copyright ARRS. For personal use only; all rights reserved
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Related Documents
