Bacillary angiomatosis: presentation of six patients, some with unusual features

Abstract

Bacillary angiomatosis (BA) is an unusual systemic vascular proliferation seen predominantly in patients with the acquired immunodeficiency syndrome. These vascular lesions are probably due to infection with a Bartonella species, most often B. henselae and, in some patients, B. quintana. BA is treatable and often curable, but without therapy, may be life-threatening. Clinically, the lesions, when superficial, are said to often resemble pyogenic granulomas, appearing polypoid histologically with an epidermal collarette. We now report six patients, three of whom showed lesions of BA morphologically and histologically distinct from the other patients reported to date. Two patients lesions appeared clinically as violaceous plaques and tumours resembling Kaposi's sarcoma; one of them had lesions histologically reminiscent of a papular angiokeratoma; and the other had lesions histologically suggestive of a combination of Kaposi's sarcoma and BA. Another patient presented with soft subcutaneous nodules which histologically showed extensive acute inflammation characteristic of an acute abscess, but which also displayed proliferating dilated small blood vessels with bulbous endothelial cells adjacent to numerous bacteria and also containing them. The Grocott-methenamine silver stain and the Warthin-Starry stain showed the organisms to better advantage in lesions of all six patients, although bacteria were also evident with the haematoxylin and eosin, periodic acid-Schiff and alcian blue stains.

Kaposi sarcoma: A continuing conundrum

“…[224][225][226][227][228][229][230][231][232][233][234][235][236][237] Patch stage KS may resemble large junctional melanocytic nevi or a nevus flammeus. Pseudo-KS and BA merit special consideration.…”

“…223 BA may resemble KS both clinically and histologically (Fig 14). [232][233][234] Cutaneously, typical BA is a violaceous angiomatous tumor or a nodule resembling a pyogenic granuloma. Subcutaneous nodules, with or without ulceration, are sometimes seen.…”

“…176,233,264 More than one of these processes may occur in the same node. KS in nodes shows the typical proliferation of spindle cells separated by slitlike spaces containing red blood cells accompanied by marked follicular hyperplasia and plasmacytic infiltration.…”

Bacillary Angiomatosis in an Immunocompetent Child: A Case Report and Review of the Literature

“…7,10-16 Finally, bone pain may result from lytic bone lesions termed osseous BA, which most frequently affects the long bones especially the tibia, fibula, and radius. [13][14][15][16]24,25 There are 3 main histological features of cutaneous BA lesions: (1) lobular proliferations of blood vessels, (2) neutrophilic infiltration, and (3) interstitial bacillary deposition. 14 The lobular proliferations of blood vessels are composed of plump ''epithelioid'' endothelial cells and are found within an edematous to fibrotic stroma.…”

Is pyogenic granuloma associated with Bartonella infection?

“…1 Bacillary angiomatosis is an infectious disease characterized by round, bright red, single or multiple nodular cutaneous lesions. [2][3][4][5] The disease is common in immunocompromised patients, mainly patients with HIV infection. 2,6 Histologic study shows circumscribed lobular proliferations of the small blood vessels.…”