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Bacillary Angiomatosis

Definition

Bacillary angiomatosis is a recently described uncommon tumor-like bacterial infection.

Etiology

The causative organisms are Bartonella henselae and quintana. The disease usually affects patients in advanced stages of HIV infection (CD₄+ lymphocytes <50 cells/mm³) and rarely other immunocompromised patients or patients with malignancies.

Main Clinical Features

Visceral, skin, and oral lesions may occur.

Oral Lesions

•Asymptomatic, dark red. slightly elevated nodule or tumor

•Soft on palpation

•Gingiva, palate, and tongue are most commonly affected

Skin Lesions

•Dark red and violaceous papules and nodules

•Usually painless

•Subcutaneous nodules which may erode the skin surface

Constitutional Symptoms

•Fever, malaise, night sweats

•Lymphadenopathy

•Abdominal pain

•Hepatosplenomegaly

•Anemia

Diagnosis

The diagnosis should be confirmed by biopsy and histologic examination.

Differential Diagnosis

•Kaposi sarcoma

•Pyogenic granuloma

•Pregnancy granuloma

•Peripheral giant cell granuloma

•Hemangioma

•Leiomyoma

•Brown giant cell tumor

•Other vascular tumors

Treatment

Basic Guidelines

•Oral bacillary angiomatosis should be regarded as an important marker for predicting the progression of HIV infection.

•Treatment is always systemic.

•Surgical excision of solitary lesions is usually not necessary.

Suggested Therapies

•Erythromycin 500 mg four times daily, or azithromycin 250 mg daily, or clarithromycin 500 mg twice daily is the drug of choice for bacillary angiomatosis. The treatment should continue for 6-8 months.

•Oral doxycycline 100 mg twice daily or oral ciprofloxacin 500-750 mg twice daily can also be used with excellent results.

References

Click M, Cleveland DB. Oral mucosal bacillary (epithelial) angiomatosis in a patient with AIDS associated with rapid alveolar bone loss: report of a case. Oral Pathol Med 1993;22:235–239.

Manders S. Bacillary angiomatosis. Clin Dermatol 1996;14:245–249.

Maurin M, Raoult D. Bartonella (Rochalimaea) quintana infections. Clin Microbiol Rev 1996;9:289–305.