PMC5066186_01
A nodule on the patient's forearm resembling a dermatofibroma.
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On inspection, widespread, polymorphic skin lesions were observed, including a nodule on the arm resembling a dermatofibroma (Fig. 1), subcutaneous nodules on the forehead (Fig. 2) and lower back, scattered papules on the limbs, an abscess-like lesion on the back, and an ulcer of the hard palate.
Hemotoxylin and Eosin stain demonstrating masses of extracellular granular amphophilic material (arrows).
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Histopathological examination of sections from a skin biopsy (Fig. 3) demonstrated proliferation of capillary sized vessels with epitheloid endothelial cells, interstitial mixed inflammatory cells, and extracellular granular amphophilic material that stained positive with Warthin-Starry stain.
Electron microscopy image of Bartonellae appearing as pleomorphic rods. Note the trilaminar cell membranes (arrow).
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Electron microscopy performed on tissue from the skin biopsy revealed bacilli with characteristic trilaminar cell membranes (Fig. 4).