What is the most likely diagnosis for a patient from the Andean region presenting with high fever, severe hemolytic anemia, and angiomatous bleeding skin lesions?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: January 25, 2026 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Enfermedad de Carrión (Bartonelosis por Bartonella bacilliformis)

El diagnóstico más probable es Enfermedad de Carrión (bartonelosis por Bartonella bacilliformis), una infección endémica de los valles andinos de Sudamérica que se presenta característicamente en dos fases: la fase aguda hemolítica (Fiebre de Oroya) seguida semanas después por la fase eruptiva crónica con lesiones cutáneas angiomatosas (Verruga Peruana). 1

Presentación Clínica Característica

La secuencia temporal y geográfica de este caso es patognomónica:

  • Fase aguda (Fiebre de Oroya): Fiebre elevada con anemia hemolítica severa, que puede alcanzar tasas de mortalidad del 90% sin tratamiento 1
  • Fase crónica (Verruga Peruana): Aparición semanas después de lesiones cutáneas angiomatosas sangrantes, que son nódulos angiomatosos superficiales y profundos 2
  • Origen geográfico: Procedencia de zona andina es crucial, ya que B. bacilliformis es endémica exclusivamente de los valles andinos sudamericanos 1

Fisiopatología Distintiva

Bartonella bacilliformis produce factores angiogénicos responsables de la neovascularización característica de las lesiones angiomatosas 2. Los humanos son el único reservorio conocido, y la transmisión ocurre a través de moscas de arena (Lutzomyia spp.) 1.

Diagnóstico Diferencial Crítico

Angiomatosis Bacilar (descartada en este caso)

  • Causada por Bartonella henselae o B. quintana 3, 2
  • Ocurre predominantemente en pacientes con VIH/SIDA 3, 2
  • Las lesiones son pápulas o nódulos rojos similares a botriomicomas 2
  • Diferencia clave: No presenta la fase hemolítica aguda severa característica de la Enfermedad de Carrión 2

Sarcoma de Kaposi (descartado)

  • Asociado con HHV-8, especialmente en pacientes VIH positivos 2
  • Presenta lesiones angiomatosas cutáneas y viscerales 2
  • Diferencia clave: No causa anemia hemolítica severa aguda precedente 2

Confirmación Diagnóstica

  • Histología: Características histológicas con demostración de bacilos mediante tinción de Warthin-Starry 2
  • Cultivo: Aislamiento de la bacteria en diversos tejidos incluyendo sangre 2
  • Frotis de sangre periférica: Durante la fase hemolítica puede mostrar fragmentación eritrocitaria 4
  • Laboratorio: Reticulocitosis, LDH elevada, bilirrubina no conjugada aumentada, haptoglobina disminuida confirman hemólisis 4

Tratamiento Recomendado

El tratamiento antibiótico es crítico para reducir la mortalidad de ~90% a prácticamente 0% 3:

  • Para B. bacilliformis: Cloranfenicol o penicilina son particularmente efectivos 2
  • Alternativas: Tetraciclinas, eritromicina también son efectivas 3
  • Duración óptima: 5-9 días parece adecuado según evidencia disponible 3

Advertencias Clínicas Importantes

  • La regresión espontánea de las lesiones cutáneas puede ocurrir en meses o años, pero el tratamiento de la fase aguda es urgente para prevenir mortalidad 2
  • No confundir con angiomatosis bacilar, que requiere macrólidos, ciclinas o fluoroquinolonas (B. henselae y B. quintana) 2
  • La procedencia geográfica andina es esencial para el diagnóstico; sin este dato epidemiológico, el diagnóstico sería extremadamente difícil 1

References

2
Research

[Infection and angiomatous cutaneous lesions].

Journal des maladies vasculaires, 1999

3
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

4
Research

Hemolytic Anemia: Evaluation and Differential Diagnosis.

American family physician, 2018

Related Questions

What is the management approach for an 18-month-old child with a history of pallor and irregularity, presenting with shortness of breath and severe anemia (hemoglobin <70), normal white blood cell count, and potential need for tests such as Lactate Dehydrogenase (LDH), electrophoresis, and Coombs test?
What is the best course of action for an 18-month-old child with a history of pallor and irregularity, who presented with shortness of breath and severe anemia, with a hemoglobin level of less than 70 g/L, normal white blood cell count, and previous episodes of hand-foot syndrome in infancy?
What is the appropriate management for a patient with mycoplasma pneumonia, on antibiotics, presenting with jaundice, mild abdominal pain, severe anemia, elevated lactate dehydrogenase (LDH), low haptoglobin, and a high reticulocyte count?
What is the diagnosis for a 10-year-old female patient presenting with pallor, splenomegaly, a total leukocyte count (TLC) of 30,000, severe anemia with a hemoglobin level of 5.6, no lymphadenopathy, elevated serum glutamic-pyruvic transaminase (SGPT) of 51, total serum bilirubin of 4.6 with unconjugated bilirubin of 3.6?
What is the appropriate management for a 13-year-old male with elevated indirect bilirubin and lactate dehydrogenase (LD), indicating possible hemolytic anemia?
What antituberculous drug is associated with optic neuritis?
What is the treatment for Tinea barbae?
What is the best course of treatment for an elderly female patient with a history of congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) who presents with severe shortness of breath (SOB) and hypoxemia?
What is the time to peak level of valacyclovir (valacyclovir hydrochloride) after oral administration in a patient with normal renal function?
How much potassium should be added to 400 mL of normal saline (NS) for an adult or adolescent patient with Diabetic Ketoacidosis (DKA) and severe metabolic acidosis?
What is premature rupture of membranes (PROM)?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question