Eruptive Angiomas

Maximilian C. Aichelburg

9th EACS Advanced HIV Course7-9 September 2011

Aix-en-ProvenceFrance

25-year old patient HIV-1 infection

– known since 02/2007– IDU– CD4+ T cells: 2/µl– HIV-1 RNA: 707946 copies/ml– ART naïve

Chronic Hepatitis C infection Homeless Malnutrition (BMI=17)

Anamnesis

Bacillary angiomatosis Rickettsiosis Kaposi sarcoma Granulomata pyogenica Eruptive senile angiomas Pityriasis lichenoides et varioliformis acuta (PLEVA) Verruga peruana

Scurvy M. Fabry M. Rendu-Osler Leukocytoclastic vaskulitis Syphilis II

Differential diagnoses

CRP 0,6 mg/dl (< 1) Moderate panzytopenia HHV-8 PCR: negative Syphilis-serology: not reactive

Laboratory findings

Warthin-Starry Staining

Bartonella quintana

16S ribosomal RNA sequence analysis from lesional skin

Identification of causative microbe

BACILLARY ANGIOMATOSIS

Diagnosis

Ultrasound:

reactive axillary and nuchal lymphadenopathy no hepatosplenomegaly

Echocardiography:

unremarkable CT (Cranium, Thorax, Abdomen):

no destruction of bone structures Eye examination:

no lesions

Medical check-up

Azithromycin 500mg once daily p. o.– Prophylaxis against atypical mycobacteria– Once daily-administration

ART: Tenofovir/Emtricitabin + Darunavir/r PCP-prophylaxis:

Sulfamethoxazole/Trimethoprim

Therapy

Bacillary Angiomatosis

Systemic infection caused by Bart. henselae (contact with cats) or quintana (homelessness; lice)

Immunocompromised patients (HIV/AIDS) correlation between number of lesions and severity of

immunosuppression

• Rash (84%), fever (62%), lymphadenopathy (45%), weight loss (35%), liver/spleen (32%), bone (16%), CNS (8%)

Gasquet et al, 1998. AIDS 12: 1793-1803

Pathogenesis

Dehio, Curr. Opin. in Microbiol., 2003 Minnick, Future Microbiol., 2009