ESPN 53rd Annual Meeting

ESPN 2021


 
SKIN LESIONS IN KIDNEY TRASPLANT RECIPIENT
ANA VINUESA JACA 1 MIREIA AGUIRRE MEÑICA 1 MARIA ROSARIO GONZALEZ HERMOSA 3 LEIRE GONDRA SANGRONIZ 4 MARIA HERRERO GOÑI 1 LEIRE MADARIAGA DOMINGUEZ 4 NELIDA GARCIA PEREZ 2

1- PEDIATRIC NEPHROLOGY, CRUCES UNIVERSITY HOSPITAL. ISS BIOCRUCES BIZKAIA
2- PEDIATRIC NEPHROLOGY, BASURTO UNIVERSITY HOSPITAL. ISS BIOCRUCES BIZKAIA
3- DERMATOLOGY, CRUCES UNIVERSITY HOSPITAL
4- PEDIATRIC NEPHROLOGY, CRUCES UNIVERSITY HOSPITAL. IIS BIOCRUCES BIZKAIA. BASQUE COUNTRY UNIVERISTY
 
Introduction:

Bacillary angiomatosis is an opportunistic infectious disease, caused by bacteria of the genus Bartonella that produce a vascular proliferative process. Apart from HIV infection it can affect other immunocompromised patients.

Material and methods:

We describe a kidney trasplant recipient who developed bacillary angiomatosis

Results:

A 12-year-old girl, adopted from Ethiopia, with chronic kidney disease diagnosed at 5 years of age of unknown origin. She received a cadaveric donor kidney transplant at the age of 11 years.After transplantation she received immunosuppressive treatment with tacrolimus, mycophenolate and prednisone with normalization of kidney function, without infectious complications. Six months after transplantation, she started with symptoms of asthenia, weight loss, nausea and joint pain in ankles and wrists. She presented skin lesions suggestive of molluscum contagiosum.Laboratory tests showed normochromic anemia, elevated CRP and ESR, renal graft dysfunction and positive BK viremia. Complement was normal and the autoimmunity study was negative. Joint ultrasound revealed a slight effusion with nodular images, suggesting schwannomas or neurofibromas as possible diagnoses. The skin lesions progressively increased in number and size to 1 cm nodules. She presented more than 100 generalized cutaneous lesions, including the gingival mucosa, with palmo-plantar involvement, with different morphologies: well-defined rounded pink-violaceous papules, subcutaneous nodular lesions and pedunculated warty papules. Biopsy showed bacillary angiomatosis with 16S rRNA gene sequencing: Bartonella quintana and serology for Bartonella quintana IgM negative and high values of IgG. She was treated with doxacycline for 3 months, with rapid progressive improvement of general symptoms, laboratory and ultrasound findings and skin lesions.

Conclusions:

The main involvement of bacillary angiomatosis is cutaneous, but it can involve other organs with risk of mortality. Early diagnosis and prolonged antibiotic treatment reduces bacteremia, parenchymal involvement and mortality.