Bacillary angiomatosis masquerading as Kaposi's sarcoma in East Africa.
BACKGROUND
Bacillary angiomatosis (BA) is a rare manifestation of infection caused by Bartonella species, which leads to vasoproliferative lesions of skin and other organs. Bacillary angiomatosis affects individuals with advanced HIV disease or other immunocompromised individuals. In sub-Saharan Africa, despite the high prevalence of HIV infection and documentation of the causative Bartonella species in humans, mammalian hosts, and arthropod vectors, BA has only rarely been described.


METHODS
Three adult patients from Uganda and Kenya with deep purple dome-shaped papules or nodules of the skin underwent punch biopsies for histopathologic diagnosis. The biopsies of all 3 patients were sent to a local pathologist as well as to a dermatopathologist at the University of California, San Francisco.


RESULTS
All 3 patients were clinically suspected to have Kaposi's sarcoma (KS), and local pathologists had interpreted the lesions as KS in 2 of the cases and nonspecific inflammation in the third. Histologic examination by dermatopathologists in the United States revealed nodular dermal proliferations of irregular capillaries lined by spindled to epithelioid endothelial cells. The surrounding stroma contained a mixed inflammatory infiltrate with lymphocytes, eosinophils, and neutrophils. Extracellular deposits of pale amphophilic granular material were noted in the surrounding stroma. A Warthin-Starry stain highlighted clumps of bacilli, confirming the diagnosis of BA.


CONCLUSIONS
These 3 cases, to our knowledge, are the first reports of BA in East Africa in the biomedical literature. Each had been originally incorrectly diagnosed as KS. We speculate BA is underdiagnosed and underreported in resource-poor regions, such as sub-Saharan Africa, that have high endemic rates of HIV infection.
Yale University School of Medicine, New Haven, CT, USA.
A K
AK
Forrestel
Department of Pathology, University of California, San Francisco, San Francisco, CA, USA.
A
A
Naujokas
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
J N
JN
Martin
Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA.
T A
TA
Maurer
Department of Pathology, University of California, San Francisco, San Francisco, CA, USA.
T H
TH
McCalmont
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA Infectious Diseases Institute, Kampala, Uganda.
M O
MO
Laker-Opwonya
Skin Clinic, Mbarara University of Science and Technology, Mbarara, Uganda.
G
G
Mulyowa
Moi University School of Medicine, Eldoret, Kenya.
N
N
Busakhala
Department of Dermatology, University of California, San Francisco, San Francisco, CA, USA amersone@derm.ucsf.edu.
Erin H
EH
Amerson
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000473:pathology; D000328:Adult; D016917:Angiomatosis, Bacillary / Q000175:diagnosis / Q000473:pathology; D001132:Arm / Q000473:pathology; D002610:Cheek / Q000473:pathology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D005385:Fingers / Q000473:pathology; D006801:Humans; D012514:Sarcoma, Kaposi; D055815:Young Adult
Africa; HIV; Kaposi’s sarcoma; bacillary angiomatosis; dermatology