Ultrasonographic findings indicating bartonella infection

Infections with Bartonella henselae or Bartonella quintana present with vas oproliferative lesions in skin and parenchymatous organs in immuncompromize d patients. A case report of a 38-year-old patient with HIV infection and h epatitis B surface antigen status is described. The dominant clinical sympt oms in our patient were fever and icterus. Ultrasonography of the abdomen s howed a picture similar to that of liver cirrhosis. Irregular (echorich) no des with hypervascularization were suspected to be hepatocellular carcinoma . Ultrasound guided puncture of one of these lesions and histological exam- ination revealed the diagnosis of bartonella infection. Under antibiotic tr eatment with clarithromycin and doxycyclin the fever and the hyperbilirubin emia decreased. The sonographically detectable lesions reduced in size. Vasoproliferative lesions in immundeficient patients caused by bartonella i nfection show a characteristic slightly hyperechogenic irregular pattern at ultrasound. Typically, circumscribed hypervascularization might be shown b y color Doppler imaging. Liver cirrhosis and diffuse tumor infiltration sho uld be excluded.