title: Bacillary angiomatosis associated with pseudoepitheliomatous hyperplasia.
abstract: Bacillary angiomatosis is an opportunistic bacterial infection caused by either Bartonella henselae or B. quintana. The classic histologic presentation of bacillary angiomatosis involves three components: a lobular proliferation of capillaries with enlarged endothelial cells, neutrophilic debris, and clumps of finely granular material identified as bacteria with staining techniques. Pseudoepitheliomatous hyperplasia is a histologic reaction pattern characterized by epithelial proliferation in response to a variety of stimuli, including mycobacterial, fungal, and bacterial infections. We describe a case of bacillary angiomatosis associated with pseudoepitheliomatous hyperplasia in an immunocompromised patient with Acquired Immunodeficiency Syndrome. Histologic examination of a finger lesion demonstrated a capillary proliferation with neutrophilic debris and characteristic amorphous granular deposits. Warthin-Starry and Giemsa staining revealed clumps of coccobacilli. Cervical lymph node tissue also revealed organisms identified as Bartonella with PCR techniques. Stains and cultures for acid fast bacilli, fungus, and bacteria were negative. To our knowledge, there has been only one other report of bacillary angiomatosis presenting with pseudoepitheliomatous hyperplasia. We conclude that the differential diagnosis of entities associated with pseudoepitheliomatous hyperplasia should be expanded to include bacillary angiomatosis.
authors.affiliation: University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Amsbaugh
authors.forename: Erin
authors.initials: E
authors.lastname: Huiras
authors.forename: Nadia S
authors.initials: NS
authors.lastname: Wang
authors.forename: Aaron
authors.initials: A
authors.lastname: Wever
authors.forename: Simon
authors.initials: S
authors.lastname: Warren
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology; D016917:Angiomatosis, Bacillary / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001473:Bartonella / Q000235:genetics / Q000302:isolation & purification; D004269:DNA, Bacterial / Q000032:analysis; D004318:Doxycycline / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004817:Epidermis / Q000473:pathology*; D005385:Fingers; D006801:Humans; D006965:Hyperplasia / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D016867:Immunocompromised Host; D008198:Lymph Nodes / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D015242:Ofloxacin; D004318:Doxycycline; D012293:Rifampin