The First Report of Bartonella quintana Immune Reconstitution Inflammatory Syndrome Complicated by Jarisch-Herxheimer Reaction.
Bacillary angiomatosis (BA) is a rare complication of human immune deficiency virus (HIV) infection in the post-antiretroviral therapy (ART) era, and few cases of BA-associated immune reconstitution inflammatory syndrome (IRIS) have been described. We report the case of a 50-year-old man who presented with mass lesions involving the skin, subcutaneous tissues, muscle, and bone. The diagnosis of Bartonella quintana BA was confirmed by serum polymerase chain reaction. The patient’s treatment course was complicated by both IRIS and Jarisch-Herxheimer reaction. The case had a favorable outcome with supportive care and continuation of ART and doxycycline.
Patients infected with tick borne infections (TBI’s) are also immunocompromised and get bacillary angiomatosis (BA). Recently, Dr. Phillips stated that the research on Bartonella is about where Lyme disease was 30 years ago, and frankly, no one is keeping track of this in relation to TBI infections. Bartonella is a persistent infection where antibiotics mainly slow down reproduction. The immune system is extremely important in fighting off Bart.
More on Bartonella: https://madisonarealymesupportgroup.com/2016/01/03/bartonella-treatment/
Lyme/MSIDS patients will identify with numerous symptoms presented below:
https://emedicine.medscape.com/article/212737-overview Bacillary angiomatosis is a vascular, proliferative form of Bartonella infection that occurs primarily in immunocompromised persons. While the disorder is treatable and curable, it may be life threatening if untreated…Lesions can also occur in the oral mucosa https://madisonarealymesupportgroup.com/2017/10/01/bartonella-in-mouth-of-hiv-infected-man/, tongue, oropharynx, nose, penis, and anus. Bone pain, frequently in the forearms or legs, can also occur.
Diagnosis is most often based on clinical features coupled with biopsies of lesions. Histology reveals vascular proliferation with the presence of neutrophils adjacent to the blood vessels and masses of bacteria, which can be demonstrated by modified silver staining (Warthin-Starry silver stain). Detection of Bartonella DNA in tissue specimens by polymerase chain reaction (PCR) assay or of Bartonella antigens by immunohistochemical methods is diagnostic. 
Radiography can be used to find bone lesions; chest radiography can reveal pulmonary parenchymal nodules. Computed tomography (CT) scanning of the brain can detect intracerebral bacillary angiomatosis. CT scanning and magnetic resonance imaging (MRI) can be used in the diagnosis of peliosis hepatis, while chest and abdominal CT scans may reveal mediastinal, retroperitoneal, or mesenteric lymph node enlargement.
Bacillary angiomatosis can be cured in most patients with antibiotics. Clinical experience strongly favors the use of erythromycin or a tetracycline derivative in this disorder.