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SynopsisBacillary angiomatosis (BA) is caused by infection with Bartonella henselae or Bartonella quintana, gram-negative rods that stimulate the proliferation and migration of endothelial cells. Trauma from cats, such as cat scratches, bites, or licks, have been associated. BA is primarily seen in human immunodeficiency virus (HIV)-infected individuals with a CD4+ count of <200 cells/µl. It has been reported in patients immunocompromised by malignancy, immunosuppressive therapy, or hepatitis B infection; very rarely may it occur in immunocompetent patients. It is rare in children. Poor socioeconomic status and living conditions are risk factors for this disease.
BA is characterized by cutaneous angiomatous papules and nodules. Other cutaneous lesions include lichenoid plaques, subcutaneous nodules, and ulcers. Organisms may disseminate systemically, in which case cutaneous lesions may be accompanied by fever, malaise, and night sweats. Multiple internal organs – including the liver (known as bacillary peliosis hepatis), spleen, bone (lytic bone lesions often under cutaneous lesions, resulting in bone pain), lung (endobronchial nodules and pulmonary infiltrates), central nervous system (CNS), cerebral masses, cardiac (endocarditis), and gastrointestinal (GI) tract – may then be involved.
Upon appropriate treatment, cutaneous lesions resolve with some hyperpigmentation or scarring.
A79.89 – Other specified rickettsioses
58213005 – Bacillary angiomatosis
Differential Diagnosis & PitfallsBA may assume numerous different distributions, including dermatomal and generalized.
The differential includes lobular capillary hemangioma, Kaposi sarcoma, and in South America, bartonellosis (verruga peruana, which is an infection with Bartonella bacilliformis).
- Disseminated mycobacterial or fungal infection