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Tumoral Bacillary Angiomatosis in a Child With Human Immunodeficiency Virus

Karolyn A. Wanat, MD1; Erika Reid, MD2; William Kamiyango, MD3; Nader Kim El-Mallawany, MD4; Carrie L. Kovarik, MD2
[+] Author Affiliations
1Department of Dermatology, University of Iowa, Iowa City, Iowa
2Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
3Children’s Foundation, Baylor College of Medicine, Lilongwe, Malawi
4Division of Hematology and Oncology, Department of Pediatrics, Baylor International Pediatric AIDS Initiative, Baylor College of Medicine, Lilongwe, Malawi
JAMA Dermatol. 2014;150(9):1015-1016. doi:10.1001/jamadermatol.2013.9128.
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Bacillary angiomatosis (BA) is a life-threatening infection caused by gram-negative organisms of the genus Bartonella that can be cured with appropriate therapy. The clinical manifestations of this infection are diverse, and a high index of suspicion and histopathologic analysis are often required to make the diagnosis.1

Article InformationCorresponding Author: Carrie L. Kovarik, MD, Department of Dermatology, Hospital of the University of Pennsylvania, 3600 Spruce St, 2 Maloney Bldg, Philadelphia, PA 19104 (carrie.kovarik@uphs.upenn.edu).

Published Online: July 30, 2014. doi:10.1001/jamadermatol.2013.9128.

Conflict of Interest Disclosures: None reported.

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Figure 1.
Bacillary Angiomatosis Clinical Presentation and Resolution With Therapy

A, At its largest size, there was a fungating tumor with overlying ulceration on the left posterior shoulder. B, After 3 months of azithromycin, the mass had resolved.

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Figure 2.
Histopathologic Images of Bacillary Angiomatosis

A, At low magnification, a lobular vascular proliferation is evident, with prominent neutrophils and hemorrhage (hematoxylin-eosin, original magnification ×400). B, Higher magnification highlights the blood vessels, neutrophils, and clumps of eosinophilic debris, denoted by arrowheads (H&E staining, original magnification ×600). C, Warthin-Starry staining highlights the organisms composing these eosinophilic clusters, denoted by arrowheads, confirming the diagnosis of bacillary angiomatosis (original magnification ×400).

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