AEGiS-14IAC: Bacillary Angiomatosis (BA) as Initial Manifestations of AIDS.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Bacillary Angiomatosis (BA) as Initial Manifestations of AIDS.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10227)

Gulotta H, Fumagalli J, Espinosa G, Toller M, Brezzo C, Troncoso A
Infectious Diseases Francisco Muniz Hospital, Buenos Aires, Argentina

BACKGROUND: BA is an unusual cutaneous complication in AIDS patient. Also, BA is a marker of advanced HIV infection. So far, it is a scarcely reported condition in Argentina.

METHODS: We report a case of BA in a 40 year-old man with unknown HIV infection and chronic, disseminated, erythematous purplish vascular nodule on the face, of three-month duration. The case, at an late stage of immunodeficiency, mimicked a Kaposi's sarcoma (KS). For the previous six months he had suffered from progressive cachexia with fever > 38.5 degrees C, chills, night sweats, arthralgias and bone pain for which no infectious or malignant cause had been discovered after an extensive medical work-up. The patient had borderline hypotension and the pulse was 100 beats/min at the time of admission.

RESULTS: Histopatological examination of the skin lesions using Warthin-Starry staining revealed lobular vascular proliferation and protuberant endothelial cells with clumps of small bacilli. Mycobacterial, viral, fungus and bacterial cultures were negative. T-CD4+ cells count 22/mm³. After instituting antibiotic therapy with clarithromycin 500 mg po bid for 4 months, the symptoms rapidly resolved.

CONCLUSION: We conclude that in pt with AIDS, BA may present as serious illness due to immunosuppression and the symptoms not remit spontaneously despite/but rapidly resolves with specific antibiotic therapy. BA is an infrequently reported cause of skin lesion, a how index of suspicion may account for this lack of recognition. Physicians should keep this opportunistic infection in mind when searching for the cause of skin lesion in AIDS patients, especially those are severely immunocompromised and when histopathologic findings excluding KS. Also, when an infectious organism is a strong clinical consideration, Warthin-Starry stains may be use when results of routine bacterial, fungus and parasitic staining are negative.

Keywords: AEGIS, Angiomatosis, Bacillary, Acquired Immunodeficiency Syndrome, Sarcoma, Kaposi, HIV Infections, CD4 Lymphocyte Count, Opportunistic Infections, Skin Neoplasms, Clarithromycin, Cachexia, Argentina, Human, Male, organization & administration

020707
B10227