Bacillary Angiomatosis

A 32-year-old construction worker sought evaluation of nontender skin lesions that had been erupting for several months. The patient was seropositive for HIV with a CD4+ cell count of 210/µL. He had no history of opportunistic infections.

The patient reported no fever, shortness of breath, pruritus, or headache. Except for the cutaneous lesions on his face and forearms, physical examination findings were normal. The lesions were round, red, papular, and nontender. A specimen obtained from a biopsy of one of the eruptions showed cutaneous vascular proliferation with numerous fusiform-appearing cells, confirming the diagnosis of bacillary angiomatosis.

Gopi Rana-Mukkavilli, MD of New York comments that bacillary angiomatosis is an unusual systemic vascular proliferation seen most commonly in adults with HIV disease. The raised lesions bleed easily when traumatized. Included in the differential diagnosis are Kaposi's sarcoma, pyogenic granuloma, and abscess.

Bacillary angiomatosis is caused by infection with Bartonella henselae; the organism can be documented by polymerase chain reaction tests and hematoxylin-eosin stain. In addition to the cutaneous lesions, a patient may have disseminated disease that can affect the lungs, liver, bones, and spleen.

Prolonged treatment with erythromycin or doxycycline usually is successful. This patient was given oral erythromycin, 500 mg four times per day for 6 weeks; his lesions disappeared within 8 weeks.