|Year : 2001 | Volume
| Issue : 1 | Page : 37-38
Bacillary angiomatosis in an immune-competent patient
Ashok Kumar Gangopadhyay , PK Sharma
Department of Dermatology, R.K.M. 5eva Pratisthan, Calcutta- 700 026, India
E-4, CGHS Dispensary, Dr. Zakir Hussain Marg, Pundar, India
Bacillary angiomatosis is reported in a 65- year- old man. He was immunocompetent and the lesions subsided following treatment with oral erythromycin.
|How to cite this article:|
Gangopadhyay AK, Sharma P K. Bacillary angiomatosis in an immune-competent patient. Indian J Dermatol Venereol Leprol 2001;67:37-8
|How to cite this URL:|
Gangopadhyay AK, Sharma P K. Bacillary angiomatosis in an immune-competent patient. Indian J Dermatol Venereol Leprol [serial online] 2001 [cited 2019 Dec 14];67:37-8. Available from: http://www.ijdvl.com/text.asp?2001/67/1/37/8133
| Introduction|| |
Bacillary angiomatosis (BA)- a recently described entity caused by a rickettsia, is a rare disorder characterised by angiomatous lesion in the skin, mucosa and internal organs. BA is mostly associated with acquired immunodeficiency syndrome (AIDS), rarely with other immunodeficient states and very rarely in healthy person. BA is rarely reported in Indian literatures. Here is a report of such a very rare case.
| Case Report|| |
An elderly person of 65 years, business- man by profession presented with multiple erythematous, nonpruritic, papular and plaque type of eruptions over the extensor aspect of the right forearm for the last two months. The patient was otherwise alright and denied history of exposure or homosexuality, nor he was on any immunosuppressive drugs. Examination revealed around ten reddish brown papules and plaques of varying sizes-1.5 cm to 2.5 cm in diameter distributed over the forearm in a linear fashion. The lesions blanched partially on diascopy. There was no mucous membrane lesion, no lymphadenopathy, or hepato- splenomegaly. Routine blood test and urinalysis showed no abnormality. Erythrocyte sedimentation rate was 20mm 1st hour. Blood sugar was 130mg. (post prandial). Chest x-ray and ultrasound study of abdomen did not reveal any pathology. Liver biopsy was not done due to inherent risk of bleeding from the angiomatous lesion, if present. Mantoux test was positive. Serum IgG was 850 mg/dl. (normal 723-1685). Serum 1gM was 120 mg/d1. (normal 60-263 mg/d1) by Rate nephlometric principle. VDRL test and ELISA tests for HIV were negative. Histology showed neovascularisation in the upper dermis. The endothelial cells of the capillaries were enlarged with clear cytoplasm giving it an appearance of epitheloid cell. There was no cellular atypia. There was not much inflammatory infiltrate nor any accumulation of eosinophils. The patient was put on a course of erythromycin (500 mg.) four times daily. The lesions disappeared completely in a course of 15 days. Identification of the causative bacillus could not be done due to lack of laboratory facility.
| Discussion|| |
BA is rather a new entry in medical vocabulary. It was first described by Stoler et al in 1983, in an AIDS patient with multiple subcutaneous tumours accompanied by fever, sweating and weight loss. Later on Cockrell et al reported similar cases. Their patients in addition to skin lesions had lesions in the liver and bone. Initial epidemiological and histopathological data suggested that the causative agent of BA is the cat scratch disease bacillus. But the lack of associated cat contact, different clinical pattern and the response to erythromycin suggest that the bacteria are not identical. A gram negative bacillus
Rochalimaca henselae - is the bacillus recently recognised as the causative agent of BA. This bacillus is demonstrated by a special stain called Warthen-Starry stain and by electron microscopic study where it appears as bacillary form with a trilamillar cell wall. The diagnosis in this particular patient was made from the unique clinical features and histological findings of neo-vascularisation in an elderly person and the therapeutic response to erythromycin. The most common risk factor for BA is HIV infection. This particular case reported herein is one of those very few patients of BA where the person is competent immunologically.
| References|| |
|1.||Johnson RA, Dover JS. Cutaneous manifestation of human immuno deficiency virus disease. in: Dermatology in General Medicine (Fitzpatrick TB, Eie AZ, Wolft K, et al. Fitzpatrick, Eisea eds) vol. 2, 4th ed. Macgrow Hill Inc., New York, 1993, P 2674. |
|2.||Benger TG, Geene I. Bacterial, viral, fungal and parasitic infection in HIV disease and AIDS - in: Dermatologic Clinics Vol. 9 Editor B.H. Thiers & LTC William James, W.B. Saunders Company, Philadelphia, 1991, p 465-492. |