Bacillary angiomatosis in a German patient with AIDS

Abstract

A 52-year old male homosexual patient with acquired immunodeficiency syndrome (AIDS) presented in our clinic with multiple nodular papules (more than 100) spread over the whole body which had developed within 3 months. Bacillary angiomatosis was suspected, which is a bacterial infectious disease recognized recently mainly in patients with AIDS. Histological and immunohistochemical examinations of extirpated skin lesions were in agreement with the diagnosis, and the detection of rod-shaped bacteria in the lesions by Warthin-Starry silver stain confirmed it. The patient was treated with 2 x 100 mg doxycycline per day. The fever disappeared, and the cutaneous lesions showed a slight tendency to improve. However, after 5 days of therapy the patient showed increasing weakness, with muscle and bone pain. The patient died 10 days after the doxycycline therapy had been started. The cutaneous lesions in bacillary angiomatosis may resemble Kaposi's sarcoma and may therefore be misdiagnosed. The disease may be fatal, but timely antibiotic treatment is usually effective; therefore, the diagnosis of bacillary angiomatosis is important. Although many cases have been reported from the United States, only one case is known from Europe. Our finding of bacillary angiomatosis in a German AIDS patient supports the concept of a worldwide distribution of this bacterial agent.

Interaction of Bartonella henselae with endothelial cells results in rapid bacterial rRNA synthesis and replication

“…Bartonella henselae is a re‐emerging human pathogen that has been associated with bacillary angiomatosis (BA), bacillary peliosis, cat scratch disease (CSD), bacteraemia and endocarditis ( Slater et al ., 1990 , 1992; Schwartzman, 1992; Adal et al ., 1994 ; Drancourt et al ., 1996; Anderson and Neuman, 1997). Histological investigations of biopsy specimens from patients with BA revealed bacteria in close association with proliferating endothelial cells ( Schneider et al ., 1993 ; Monteil et al ., 1994 ). This angiogenic process is likely to be induced by B. henselae as bacterial eradication by antibiotic treatment results in a complete regression of angiomatous tumours ( Webster et al ., 1992 ).…”

Formation of stress fibres in human endothelial cells infected with Bartonella bacilliformis is associated with altered morphology, impaired migration and defects in cell morphogenesis

“…Histologically, the verrugas are characterized by a marked concentration of B. bacilliformis , both within the cytoplasm of endothelial cells and extracellularly in the surrounding interstitium. The existence of numerous capillaries and pseudocapillaries within verrugas suggests that Bartonella infection of endothelial cells provokes a local angiogenic response (Arias‐Stella et al ., 1987; Schneider et al ., 1993). Verrugas are histologically very similar to the haemangioma‐like lesions of bacillary angiomatosis, associated with infection by B. henselae in immunocompromised patients (Tappero et al ., 1993), as well as those observed in Kaposi's sarcoma.…”

Bacillary Angiomatosis in HIV-Infected Patients – An Epidemiological and Clinical Study

“…In 1993, the first cases of BA were described in Germany [11, 12]. Although a few cases were reported during the following years [13], no synopsis of the different BA infections in Germany was carried out.…”