Eruptive Angiomas Maximilian C. Aichelburg 9th EACS Advanced HIV Course 7-9 September 2011 Aix-en-Provence France

25-year old patient HIV-1 infection –known since 02/2007 –IDU –CD4 + T cells: 2/µl –HIV-1 RNA: 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, AIDS 12:

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