key: cord-0066465-9bk1ed49
authors: Nel, Jeremy; Ive, Prudence; Nel, Carolina
title: Giant bacillary angiomatosis
date: 2021-07-20
journal: South Afr J HIV Med
DOI: 10.4102/sajhivmed.v22i1.1257
sha: 597e688603cfd8f5865f3bf2ff42f874fe3a862a
doc_id: 66465
cord_uid: 9bk1ed49

nan

A 45-year-old female patient presented with a 2-month history of a progressively enlarging and ulcerating mass on her upper right chest wall, associated with weight loss of 20 kg (Figure 1a ). The mass measured 12 cm in diameter and had become gradually more painful as the lesion expanded. The patient was newly diagnosed with HIV-1 infection, with a baseline CD4+ T-cell count of 10 cells/mm 3 and a viral load of 38 000 copies/mL. Initially a diagnosis of non-Hodgkin's lymphoma was considered, but a biopsy revealed that the lesion consisted of a proliferation of capillaries lined by plump endothelial cells. A Warthin-Starry stain highlighted bacilli morphologically in keeping with Bartonella species (Figure 1b , arrows). An indirect immune fluorescence antibody assay for Bartonella henselae immunoglobulin G was strongly positive (> 1:256) , and the biopsy sample tested positive for Bartonella by polymerase chain reaction, confirming the diagnosis of bacillary angiomatosis. Oral azithromycin therapy resulted in rapid improvement, with abatement of the pain within two days and regression of the lesion to half its original size within two weeks. Antiretroviral treatment was commenced simultaneously. Complete resolution of the lesion was accomplished after nine weeks of therapy, leaving only mild residual scarring (Figure 1c ). To the best of our knowledge, this 12-cm lesion is the largest described in the literature to date.

J.N. drafted the manuscript. P.I. and C.N. reviewed the manuscript.

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Ethical approval for this study was obtained from the University of the Witwatersrand's Human Research Ethics Committee (clearance number: M1909103)

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

The authors received no financial support for the research or authorship of this article.

Data sharing is not applicable to this article.

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.