AUTHOR AND EDITOR INFORMATION

Section 1 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

INTRODUCTION

Section 2 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Background

Bacillary angiomatosis (BA) is the vascular proliferative form of infection with Bartonella organisms. Bacillary angiomatosis was first described in 1983 in a patient infected with the human immunodeficiency virus (HIV). Subsequently, it has been described in patients following organ transplants and in immunocompromised persons. It is occasionally reported in patients who are immunocompetent. Initially, bacillary angiomatosis was called epithelioid angiomatosis because of its histological appearance.

In 1990, Relman et al identified a visible but uncultivable bacillus from affected tissues using molecular methods. They concluded that the unique 16S gene sequence associated with epithelioid angiomatosis belonged to a previously uncharacterized microorganism, most closely related to Rochalimaea quintana. Later, the same organism was recovered in specialized culture media. The gram-negative organism was later named Rochalimaea henselae, and, in 1993, Rochalimaea was reclassified under the genus Bartonella. Bartonella henselae and Bartonella quintana each have been cultured from and detected in bacillary angiomatosis tissues. Bacillary angiomatosis is the second most common angiomatous skin lesion in patients infected with HIV.

Pathophysiology

B henselae and B quintana are small gram-negative rods in the family Bartonellaceae. Bartonella, Rickettsia, Ehrlichia, and Afipia species all are part of the alpha-2 subgroup of the alpha-proteobacteria.

Bacillary angiomatosis may affect almost any organ system, although it most commonly affects skin and subcutaneous tissue. Subcutaneous lesions may erode into underlying bones (ie, osseous bacillary angiomatosis), especially the tibia, fibula, and radius. Involvement of ribs and vertebrae has been described. Rarely, skeletal muscles may be involved, resulting in pyomyositis. Mucous membranes of the conjunctiva and upper airway and perineum (anus and penis) may be affected. Bacillary angiomatosis may be accompanied by disseminated visceral disease (peliosis), mainly in the liver (peliosis hepatis), spleen, and lymph nodes.

Other internal organs that may be involved include the brain, bone marrow, heart, lungs, pleura, larynx, oropharynx, tongue, esophagus, stomach, duodenum, colon, peritoneum, diaphragm, kidneys, adrenal glands, pancreas, uterine cervix, and vulva. Extrinsic compression of the common bile duct by enlarged peripancreatic, celiac, and portohepatic nodes has been reported.

The pathogenesis of bacillary angiomatosis includes early blood-borne dissemination of organisms. Bartonella organisms readily attach to and may enter erythrocytes. They avoid opsonization and host phagocytosis by unknown mechanisms and become persistent within the intravascular compartment. An angiogenic factor may be responsible for the vascular proliferation observed in patients with bacillary angiomatosis because a similar factor mediates vasoproliferation in verruca peruana, the second stage of Bartonella bacilliformis infection.

Cutaneous lesions result almost equally from B henselae and B quintana infections. However, subcutaneous and osseous lesions usually are caused by B quintana infection. Visceral involvement is almost exclusively caused by infection with B henselae. Neurological disorders are associated more frequently with B quintana infection than with B henselae.

Domestic cats (Felis domesticus) are the reservoirs of B henselae, which may be transmitted by cat bites or scratches or, potentially, by bites from cat fleas (Ctenocephalides felis). Kittens are more frequently associated with transmission of B henselae than older cats. Humans appear to be the only reservoir of B quintana; the human body louse, Pediculus humanus, is the transmission vector.

Frequency

United States

The exact incidence of bacillary angiomatosis is not known. Cases of bacillary angiomatosis have been reported in almost all states, especially in Florida, Texas, New York, and northern California (San Francisco area), areas of high HIV prevalence.

International

Relatively fewer cases of bacillary angiomatosis are reported from Europe compared to North America, which may imply that either diagnoses are missed or a minimal reservoir of bacilli exists in Europe. Cases have also been reported from Africa, Peru, and Argentina.

Mortality/Morbidity

The exact mortality and morbidity of bacillary angiomatosis is not known because the condition was described only recently.

Race

Approximately 40% of US patients with bacillary angiomatosis are white, 40% are black, and 20% are of Hispanic origin.

Sex

Approximately 90% of US patients with bacillary angiomatosis are men, probably because a disproportionate number of patients infected with HIV also are men.

Age

Bacillary angiomatosis is extremely rare in children but was reported in a 12-year-old boy with acute leukemia who was undergoing chemotherapy and also in a 6-year-old girl who was immunocompetent.

CLINICAL

Section 3 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

History

• Most patients are infected with HIV and have CD4⁺ cell counts of less than 200/µL.
• The duration of symptoms before diagnosis is usually several months.
• Symptoms resulting from skin, subcutaneous, mucosal, and osseous lesions include the following:
• • Raised red or purple lesions in the skin that bleed when traumatized
  • Similar lesions in the oral mucosa, tongue, oropharynx, nose, penis, or anus
  • Bone pain, frequently in the forearms or legs
• Symptoms resulting from visceral involvement may include the following:
• • Asymptomatic
  • Fever, chills, malaise, night sweats, anorexia, and weight loss
  • Abdominal pain, nausea, vomiting (peliosis hepatis)
  • Jaundice secondary to biliary obstruction as a result of external compression of periportal lymph nodes
  • Intra-abdominal mass and gastrointestinal bleeding
  • Abdominal cramps, tenesmus, and bloody diarrhea (colonic bacillary angiomatosis)
  • Psychiatric symptoms, such as exacerbation of depression or new-onset psychosis; personality changes, including anxiety and irritability; headache; trigeminal neuralgia; seizures; or back pain (central nervous system bacillary angiomatosis)
  • Difficulty in breathing secondary to laryngeal obstruction
• Underlying disease conditions may include the following:
• • Commonly, a history of HIV infection, organ transplantation, leukemia, or chemotherapy
  • Bacillary angiomatosis developing prior to HIV seroconversion in some patients
  • Apparent immunocompetence in some patients
• Bacillary angiomatosis was reported in a patient who was HIV-seronegative but had idiopathic thrombocytopenic purpura, had undergone splenectomy, and had been administered long-term systemic prednisone. Another recent report described an immunocompetent child with infected facial wound, in the vicinity of which bacillary angiomatosis lesions had developed. Similar lesions also appeared at the donor site of the skin graft, which was grafted on the facial wound. Multiple leg ulcers caused by bacillary angiomatosis without a history of direct contact with cats in an adult immunocompetent man has also been reported.

Physical

• Skin and subcutaneous lesions
• • Cutaneous lesions may take one of the following forms: (1) solitary or multiple red, purple, flesh-colored, or colorless papules (hemangiomalike lesions) varying in size from 1 mm to several centimeters; (2) nodules, often covered with a fine tightly adherent scale; (3) large, friable, pedunculated, or polypoid exophytic masses; or (4) hyperpigmented, hyperkeratotic, indurated plaques, typically on extremities, often overlying osseous defects.
  • The number of lesions may vary from 1 to more than 1000, and often they are multiple. The lesions on patients with multiple lesions often demonstrate more than one morphological appearance. Black patients, in particular, may bear the plaque form.
  • Cutaneous lesions may develop ulceration, discharge, and crusting and often are tender. Smaller lesions tend to be covered with an attenuated epidermis, while larger lesions tend to erode and bleed. Most lesions are rubbery and firm upon palpation and are usually freely mobile. They may be associated with regional lymphadenopathy. Lesions may undergo spontaneous regression, but this is rare.
  • Subcutaneous nodules may erode through the surface and become friable and superinfected. Deep lesions are usually uncolored and either mobile or fixed to the underlying tissues. They often are tender. The overlying skin may appear normal.
• Mucosal lesions: These are similar to other lesions and may involve oral, conjunctival, nasal, anal, or penile mucosal surfaces.
• Visceral involvement
• • Visceral involvement may lead to fever, abdominal distension, hepatomegaly, and splenomegaly. This involvement may eventually progress to bacteremia and sepsis syndrome.
  • Neurological deficits may be present in patients with intracranial mass lesions.
  • Visceral involvement may occur in the absence of cutaneous lesions. In this case, the diagnosis often is delayed because the manifestations of visceral involvement are nonspecific.
  • A recent retrospective analysis of 37 speciated bacillary angiomatosis cases demonstrated that fever was present in two thirds of the patients and weight loss in one third of the patients, including patients without extra-cutaneous involvement.

Causes

• Risk factors for bacillary angiomatosis include the following:
• • HIV infection
  • Chronic lymphocytic leukemia
  • Cytotoxic chemotherapy
  • Organ transplantations
• Additional risk factors for bacillary angiomatosis associated with B henselae infection include the following:
• • Cat ownership
  • Cat bites
  • Cat scratches
• Additional risk factors for bacillary angiomatosis associated with B quintana infection include the following:
• • Homelessness
  • Low socioeconomic status
  • Exposure to body and hair lice

DIFFERENTIALS

Section 4 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Other Problems to be Considered

Pyogenic granuloma
Common wart
Hemangioma
Dermatofibroma
Angiokeratoma
Verruga peruana
Infections caused by Mycobacterium haemophilum, Mycobacterium kansasii, and Mycobacterium marinum

WORKUP

Section 5 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Lab Studies

• Anemia, leukopenia, and CD4⁺ cell counts of fewer than 0.2 X 10⁹/L are observed most commonly in patients with bacillary angiomatosis who are also infected with HIV. In a series of 42 patients with bacillary angiomatosis, the average CD4⁺ cell count was 0.021 X 10⁹/L. A rapid drop in hemoglobin in the absence of bleeding or hemolysis has been reported in a patient with peliosis and was thought to be secondary to the sequestration of blood into pools in a liver or spleen that was massively enlarged. Thrombocytopenia with coagulopathy may also occur with peliosis.
• Indirect immunofluorescent antibody test to detect antibodies to B henselae has been used to diagnose bacillary angiomatosis. Immunoglobulin (IgG) titers of higher than 1:64 against B henselae are suggestive of disease. An enzyme immunoassay for the detection of IgG antibodies to B henselae is now available and is reported to be 5-10 times more sensitive than the indirect fluorescent antibody test.
• Blood cultures may yield organisms if grown at 35°C in 5% carbon dioxide for 3 weeks using a lysis centrifugation technique. B henselae colonies are rough, cauliflower-like, and usually deeply embedded in the agar. B quintana colonies are smooth, flat, and shiny and do not pit the agar. Whole cell fatty acid gas chromatography has been used to identify the organisms once they have grown in culture.
• Culture of Bartonella from solid tissue is more difficult but possible.
• The diagnosis of cutaneous bacillary angiomatosis and extracutaneous disease is most often based on clinical features coupled with biopsies of lesions and appropriate tissue staining (see Histologic Findings). Detection of Bartonella DNA in tissue specimens by polymerase chain reaction or Bartonella antigens by immunohistochemical methods is diagnostic.
• Elevation of alkaline phosphatase, gamma-glutamyltransferase, and transaminase levels may indicate hepatic involvement. Alkaline phosphatase levels are more markedly elevated (5 times normal on average) than transaminase levels, which are usually mildly to moderately elevated or normal.

Imaging Studies

• Radiographs of the bones overlying the skin lesions may demonstrate simple cortical erosions, osteolytic lesions, extensive cortical destruction, or a periosteal reaction. Bone scan findings are always positive at the site of osseus lesions and may help identify the additional areas of involvement not revealed by conventional radiographs.
• In peliosis hepatis, a CT scan of the liver may demonstrate hypodense ringlike lesions that may enhance with contrast. The absence of mass effect on adjacent vasculature is characteristic. On MRI, the lesions appear bright on T2-weighted images and dark on T1-weighted images. Enhancement patterns of one published MRI case study suggests centripetal enhancement similar to hemangioma, but another MRI case study suggests centrifugal enhancement.
• CT scan of the chest and abdomen may reveal mediastinal, retroperitoneal, or mesenteric lymph node enlargement.
• In intracerebral bacillary angiomatosis, CT scan of the brain reveals a contrast-enhancing mass lesion.

Procedures

• Biopsy specimens of skin, subcutaneous or mucosal lesions, or, in case of peliosis hepatis, the liver, are diagnostic.
• With gastrointestinal involvement, endoscopic studies may reveal ulcerated nodules of the mucosa of the stomach, small intestine, or large intestine.
• With lung involvement, bronchoscopy may reveal polypoid lesions.

Histologic Findings

Histological examination of skin lesions reveals vascular proliferation involving small blood vessels that contain plump cuboidal epithelial cells interspersed with polymorphonuclear inflammatory cell infiltrates and clumps of granular purple material. Coincidental endothelial cell necrosis and cytological atypia may lead to a misdiagnosis of angiosarcoma. Solid areas of spindle cells may also be present, which, in some cases, mimic Kaposi sarcoma or other sarcomas.

Histological examination of liver sections in peliosis hepatis reveals dilated blood-filled spaces in the fibromyxoid stroma that contain inflammatory cells, dilated capillaries, and clumps of granular purple material.

Histological examination of lymph nodes reveals coalescing nodules of proliferated small blood vessels, some with prominent endothelial cells, in the cortical and paracortical areas. The uninvolved parenchyma may show follicular hyperplasia, plasmacytosis, or sinus histiocytosis.

Histological examination of the bone reveals a lobular proliferation of small blood vessels with prominent endothelial cells. Neutrophils may be sparse, and their lobular nature may not be apparent in some bone biopsy findings.

Bacillary angiomatosis lesions of the lymph nodes, bone, and brain may demonstrate a less lobular pattern than cutaneous lesions and have a less prominent neutrophilic infiltrate.

The granular purple material in tissue sections stained with hematoxylin and eosin are masses of bacteria, which can be demonstrated by modified silver staining (Warthin-Starry silver stain) or electron microscopy. However, the major draw back of Warthin-Starry silver stain is lack of specificity. Other organisms that stain positive with Warthin-Starry silver stain include Legionellae species (Legionnaires pneumonia), Nocardia species (nocardiosis), Trophermyma whippleii (Whipple disease), Afipia felis (catscratch disease), Treponema pallidum (syphilis), Borrelia burgdorferi (Lyme disease), and Helicobacter pylori (chronic active gastritis). However, bacillary angiomatosis is clinically distinguishable from infections caused by these organisms, except for Nocardia brasiliensis.

Transmission electron microscopy reveals clumps of pleomorphic bacilli measuring 0.2-0.5 µm by 1-3 µm that have a trilaminar structure to the cell walls, which is typical of vegetative forms of gram-negative bacilli.

TREATMENT

Section 6 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Medical Care

Recognition of bacillary angiomatosis is critical because antibiotics cure most patients. Treatment recommendations are based on retrospective studies or clinical observations. No antibiotics have been studied prospectively.

• Clinical experience strongly favors the use of erythromycin or a tetracycline derivative. Erythromycin remains the drug of choice because it has an excellent clinical response in almost all patients. Tetracyclines are the first alternative for patients who cannot tolerate erythromycin. A combination of doxycycline (100 mg PO/IV q12h) plus rifampin (300 mg PO bid) may be used in patients with severe disease who are immunocompromised.
• Other antibiotics display in vitro activity, but in vitro susceptibility data do not accurately predict success in vivo. Penicillins and cephalosporins have no activity against Bartonella, despite in vitro susceptibilities. Clarithromycin, azithromycin, chloramphenicol, ciprofloxacin, trimethoprim-sulfamethoxazole, rifampin, isoniazid, and gentamicin combined with either doxycycline or ciprofloxacin produce good clinical responses. These antibiotics have been used successfully in limited numbers of patients. Treatment failures with ciprofloxacin, trimethoprim-sulfamethoxazole, isoniazid, and rifampin have been reported.
• A reaction resembling the Jarisch-Herxheimer reaction has been described upon the initiation of appropriate antibiotic therapy. The reaction is characterized by fever, myalgias, and constitutional symptoms.
• The optimal duration of therapy is not known. Recommendations are based on clinical experience rather than scientific data. Usually, recommendations indicate to treat skin lesions for 8-12 weeks and osseous and liver lesions for at least 3 months, although these have not been studied in prospective randomized trials. Patients with HIV infection may require life-long therapy if relapses occur.
• The cutaneous lesions resolve substantially after approximately 4-7 days of therapy, and usually they resolve completely after 1 month.
• Corticosteroid therapy, cytotoxic therapy, or radiation therapy is not effective.

Surgical Care

Cryotherapy, electrodesiccation and curettage, and surgical excision of solitary cutaneous lesions can be useful as adjunctive therapy. However, antibiotic therapy provides treatment for possible occult dissemination of bacteria, in addition to regression of the lesions.

Consultations

• Infectious diseases specialist
• Dermatologist

Diet

• No special dietary restrictions

Activity

• No restriction of physical activity

MEDICATION

Section 7 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

The goals of pharmacotherapy are to eradicate infection, to reduce morbidity, and to prevent complications.

Drug Category: Antibiotics

Empiric antimicrobial therapy should cover all likely pathogens in the context of the clinical setting.

Drug Name	Clarithromycin (Biaxin)
Description	Semisynthetic macrolide antibiotic that inhibits bacterial protein synthesis by binding 50S ribosomal subunits.
Adult Dose	500 mg PO q12h ER formulation: 1000 mg PO qd
Pediatric Dose	<6 months: Not recommended >6 months: 7.5 mg/kg PO divided bid, not to exceed 500 mg PO q12h
Contraindications	Documented hypersensitivity, coadministration of pimozide
Interactions	Toxicity increases with coadministration of fluconazole, astemizole, and pimozide; effects decrease and adverse GI effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, carbamazepine, ergot alkaloids, triazolam, and HMG CoA-reductase inhibitors; arrhythmia and increased QTc intervals occur with disopyramide (resulting from increased levels)
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min; give half dose or increase dosing interval if CrCl <30 mL/min; reduce dose if given with ritonavir in renal impairment; diarrhea may be sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies; caution in breastfeeding

Drug Name	Azithromycin (Zithromax)
Description	Macrolide that inhibits bacterial protein synthesis by binding 50S ribosomal subunits.
Adult Dose	Day 1: 500 mg PO Days 2-5: 250 mg PO q24h
Pediatric Dose	<6 months: Not established >6 months Day 1: 10 mg/kg PO once 1 h ac or 2 h pc, not to exceed 500 mg/d Days 2-5: 5 mg/kg PO qd 1 h ac or 2 h pc, not to exceed 250 mg/d
Contraindications	Documented hypersensitivity; hepatic impairment; do not administer with pimozide
Interactions	May increase toxicity of theophylline, warfarin, carbamazepine, phenytoin, ergot alkaloids, triazolam, hexobarbital, cyclosporine, and digoxin; effects are reduced with coadministration of aluminum or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine
Pregnancy	B - Usually safe but benefits must outweigh the risks.
Precautions	Site reactions can occur with IV route; bacterial or fungal overgrowth may result with prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function, prolonged QT intervals, or pneumonia; caution in patients who are hospitalized, elderly, or debilitated; monitor for pseudomembranous colitis; caution in breastfeeding

Drug Name	Doxycycline (Vibramycin)
Description	Bacteriostatic antibiotic that inhibits bacterial protein synthesis by binding 30S ribosomal subunits.
Adult Dose	100 mg PO/IV q12h
Pediatric Dose	<8 years: Not recommended >8 years: 1 mg/kg/d PO/IV divided bid if <45 kg and as in adults if >45 kg
Contraindications	Documented hypersensitivity, severe hepatic dysfunction, pregnancy, breastfeeding
Interactions	Effects decrease with carbamazepine, phenytoin, barbiturates, and antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; may increase digoxin levels; avoid concomitant use with methoxyflurane because of risk of fatal renal toxicity; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy
Pregnancy	D - Unsafe in pregnancy
Precautions	Photosensitivity may rarely occur; use during tooth development (last half of pregnancy through 8 y) can cause permanent discoloration of teeth

Drug Name	Rifampin (Rifadin, Rimactane)
Description	Bactericidal antibiotic that inhibits bacterial protein synthesis by inhibiting DNA-dependent RNA polymerase. Useful in immunocompromised patients with severe disease.
Adult Dose	300 mg PO q12h
Pediatric Dose	10 mg/kg/d PO, not to exceed 600 mg/d
Contraindications	Documented hypersensitivity
Interactions	Induces microsomal enzymes, which may decrease effects of acetaminophen, oral anticoagulants, barbiturates, benzodiazepines, beta-blockers, chloramphenicol, oral contraceptives, corticosteroids, mexiletine, cyclosporine, protease inhibitors, digitoxin, disopyramide, estrogens, hydantoins, methadone, clofibrate, quinidine, dapsone, tazobactam, sulfonylureas, theophyllines, tocainide, and digoxin; blood pressure may increase with coadministration of enalapril; concomitant administration with atovaquone increases serum concentration of rifampin and decreases serum concentration of atovaquone; probenecid and trimethoprim-sulfamethoxazole may increase levels; coadministration with isoniazid may result in higher rate of hepatotoxicity than with either agent alone (discontinue one or both agents if alterations in LFTs occur)
Pregnancy	C - Safety for use during pregnancy has not been established.
Precautions	Obtain CBC counts and baseline clinical chemistries prior to and throughout therapy; in liver disease, weigh benefits against risk of further liver damage; interruption of therapy and high-dose intermittent therapy are associated with thrombocytopenia that is reversible if therapy is discontinued as soon as purpura occurs; if treatment is continued or resumed after appearance of purpura, cerebral hemorrhage or death may occur; caution in breastfeeding

FOLLOW-UP

Section 8 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Further Outpatient Care

• For cutaneous lesions, the number and size of the lesions should be monitored to determine the efficacy of treatment.
• For visceral involvement, imaging study findings, hepatic transaminase levels, organomegaly, or lymph node enlargement should be monitored to determine response to therapy.

Deterrence/Prevention

• Prevention of bacillary angiomatosis associated with B henselae infection is as follows:
• • Avoid cat contact.
  • Control flea infestations in cats.
• Prevention of bacillary angiomatosis associated with B quintana infection is as follows:
• • Delousing procedures, such as permethrin dusting powder (1%, 30-50 g per adult), can be used.
  • Clothing and bedding should also be treated.
• Use of macrolides for Mycobacterium avium-intracellulare prophylaxis in patients infected with HIV is protective against bacillary angiomatosis.

Complications

• Disfigurement
• Biliary obstruction and jaundice
• Gastrointestinal bleeding
• Encephalopathy
• Laryngeal obstruction and asphyxiation

Prognosis

• Prognosis of bacillary angiomatosis itself is excellent because antibiotics are curative in most patients.
• Untreated bacillary angiomatosis may be progressive and life-threatening.
• The lesions resolve completely after treatment. Hyperpigmentation or slight induration at the site of a lesion may persist indefinitely. Relapses can occur after cessation of therapy and are common in immunocompromised hosts.
• Treatment may be more difficult and require a longer duration of therapy if the diagnosis is delayed.
• Overall prognosis depends on early detection and treatment and the degree of immunosuppression.

Patient Education

• Patients who are immunocompromised and also their caregivers should be advised to avoid cat contact and control flea infestations in cats.

MISCELLANEOUS

Section 9 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Medical/Legal Pitfalls

• Failure to distinguish Kaposi sarcoma from bacillary angiomatosis may raise legal issues because bacillary angiomatosis, unlike Kaposi sarcoma, responds dramatically to antibiotic therapy. Furthermore, bacillary angiomatosis may be life-threatening if untreated. Bacillary angiomatosis may coexist with Kaposi sarcoma, in which case, the lesions of bacillary angiomatosis may be easily overlooked.

Special Concerns

• Doxycycline is contraindicated in pregnancy.
• Azithromycin can be used in case of intolerance to erythromycin.

REFERENCES

Section 10 of 10

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

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Article Last Updated: Mar 30, 2006