81. Pathology 850 Block 4 Exam A. aldosteronesecreting adrenal tumor B. angiosarcoma C. bacillary angiomatosisD. berry aneurysm E. cholesterol embolism F. dissecting aneurysm G. essential http://www.kumc.edu/instruction/medicine/pathology/ed/exams/exam4_f96.html

Pathology 850 Block 4 Exam 21 November 1996 A 30 year-old male develops a severe headache, rapidly becomes comatose and succumbs to a fatal subarachnoid hemorrhage. Select the most likely diagnosis. A. aldosterone-secreting adrenal tumor B. angiosarcoma C. bacillary angiomatosis D. berry aneurysm E. cholesterol embolism F. dissecting aneurysm G. essential hypertension H. giant cell arteritis I. glomus tumor J. Kaposi sarcoma K. leukocytoclastic vasculitis L. lymphedema M. malignant hypertension N. Monckeberg medial sclerosis O. mycotic aneurysm P. polyarteritis nodosum Q. pheochromocytoma R. Raynaud phenomenon S. tertiary syphilis T. Wegener granulomatosis A 70 year-old male develops a reddish purple nodule in his scalp. He is HIV negative. A biopsy of the nodule reveals a vascular lesion composed of markedly pleomorphic endothelial cells with hyperchromatic nuclei. Select the most likely diagnosis. A. aldosterone-secreting adrenal tumor B. angiosarcoma C. bacillary angiomatosis D. berry aneurysm E. cholesterol embolism F. dissecting aneurysm

82. Bacillary Angiomatosis Printed from www.lifesteps.com URL http//www.lifesteps.com/gm/Atoz/ency/bacillary_angiomatosis.jsp,bacillary angiomatosis. Definition. http://www.lifesteps.com/gm/Atoz/ency/bacillary_angiomatosis_pr.jsp

83. A MAN WITH RED NODULES ON THE FACE AND EXTREMITIES These findings were consistent with bacillary angiomatosis. COURSE ANDTHERAPY. What is your diagnosis? POSTER 3—bacillary angiomatosis. http://www.med.wayne.edu/dermatology/webmichderm01/poster3.htm

POSTER 3—A MAN WITH RED NODULES ON THE FACE AND EXTREMITIES Brett Dock MD, Meena Moossavi MD, George Murakawa MD PhD HISTORY A 37 year old HIV positive African-American man was admitted with a 3 month history of red lesions on his face and extremities. The patient complained of pain and pus draining from the lesion on his right knee. He denied contact with cats, was not homeless, and had no history of body lice. The lesions sometimes bled, but were otherwise asymptomatic. The patient was stable and afebrile. He had discontinued all medications 2 months prior to admission. He had no known drug allergies and no other medical history. EXAMINATION Examination revealed a 5 cm x 6 cm soft, purulent, tender, necrotic tumor on the right knee. There was a 1.2 cm umbilicated erythematous tumor on the left elbow and 4 cm violaceous tumors on the left knee and left ankle. The patient had right inguinal lymphadenopathy. LABORATORY Blood cultures: negative CD T-helper cell count: 20 HISTOPATHOLOGY Biopsies of the temple and elbow revealed a proliferation of blood vessels lined by epithelioid endothelial cells. There was a perivascular neutrophilic inflammatory infiltrate and amorphous eosinophilic material. Warthin-Starry stain revealed positively staining bacilli. These findings were consistent with bacillary angiomatosis. COURSE AND THERAPY The patient was treated with azithromycin 250 mg qd. Antiretroviral therapy and Bactrim prophylaxis were started. The lesions rapidly improved within one week after starting therapy.

84. Pathologic Quiz Case: A 17-Year-Old Renal Transplant Patient With Persistent Fev 3. What is your diagnosis? Pathologic Diagnosis bacillary angiomatosisof the Lymph Node in the Renal Transplant Recipient Return to TOC. http://arpa.allenpress.com/arpaonline/?request=get-document&doi=10.1043/1543-216

85. The Johns Hopkins Microbiology Newsletter Biopsies of the skin and the pharyngeal lesions were consistent with BacillaryAngiomatosis (BA). Warthin bacillary angiomatosis. Bacillary http://pathology5.pathology.jhmi.edu/micro/v16n36.htm

DEPARTMENT OF PATHOLOGY The Johns Hopkins Medical Institutions Vol. 16, No. 36 THE JOHNS HOPKINS MICROBIOLOGY NEWSLETTER Monday, September 22, 1997 A. Provided by Carmela Groves, R.N., M.S., Chief, Division of Outbreak Investigation, Maryland Department of Health and Mental Hygiene 11 outbreaks were reported between August 29 and September 22, 1997. 5 outbreaks of foodborne gastroenteritis associated with food service facilities 2 outbreaks of upper respiratory illness associated with long term care facilities 1 outbreak of scabies 1 outbreak of group A streptococcal infection 2 outbreaks of gastroenteritis associated with long term care facilities B. The Johns Hopkins Hospital: Information provided by David Taylor, M.D., Pathology Clinical Information Bacillary Angiomatosis Bacillary Angiomatosis is a reactive vascular proliferation caused by bacilli of the genus Bartonella (formerly Rochalimaea ), specifically B. henselae and B. quintana Bartonella spp. are small gram-negative rods that are often slightly curved. BA was initially described in the skin, but can occur in a variety of organs or as septicemia. First reports were in patients infected with HIV; infections were subsequently identified in other immunocompromised hosts and later in some apparently immunocompetent patients as well. Epidemiology : The geographic distribution of BA largely parallels that of HIV infection. BA is at least in part a zoonosis because one of its agents

86. Vol Special stains for organisms were negative. bacillary angiomatosis. Introductionbacillary angiomatosis (BA) was first described in 1983 in a patient with HIV. http://pathology5.pathology.jhmi.edu/micro/v20n45.htm

DEPARTMENT OF PATHOLOGY The Johns Hopkins Medical Institutions Vol. 20, No. 45 THE JOHNS HOPKINS MICROBIOLOGY NEWSLETTER Tuesday, November 6, 2001 A. Provided by Leslie Edwards Reger, Division of Outbreak Investigation, Maryland Department of Health and Mental Hygiene. No information available. B. The Johns Hopkins Hospital, Department of Pathology. Information provided by Rob Law, M.D. Case Description A 26 year old HIV infected male with a CD4 count of 4 cells/mm presented to his PMD with a three month history of malaise, fever, abdominal cramping, and fatigue. He had been recently discharged from an outside hospital with a diagnosis of fever of unknown origin and a hematocrit of 29%. Initial workup revealed a hematocrit of 22%. The patient owns a cat, and reports playing with a friend’s kitten several months ago. Bacterial, AFB, and fungal cultures were all negative. An abdominal CT revealed hepatomegaly with punctate echogenic foci in the liver and spleen, raising the possibility of peliosis hepatis. Empiric therapy was begun. Serologies for Bartonella henselae were positive at 1:256, and a liver biopsy revealed dilated vascular spaces and focal lymphoplasmacytic inflammation. Special stains for organisms were negative.

87. Dermatologic Manifestations Of HIV Infection - New Treatments, March 2, 2004 bacillary angiomatosis. bacillary angiomatosis is an infection causedby two species of Bartonella B. henselae and B. quintana. http://www.medical-library.org/journals2a/derm.htm

Click here to view next page of this article Dermatologic Manifestations of HIV Infection Infectious cutaneous conditions Staphylococcus aureus infections Staphylococcus aureus is the most common bacterial skin infection in persons with HIV disease. Bullous impetigo . Bullous impetigo is most common in hot, humid weather, presenting as very superficial blisters or erosions, most commonly seen. Ecthyma is an eroded or superficially ulcerated lesion with an adherent crust. Purulent material is present under this crust. Folliculitis Folliculitis due to S. aureus occurs most commonly in the hairy areas of the trunk, groin, axilla, or face. Often the follicular lesions of the trunk are intensely pruritic and may be mistaken for scabies. About 50% of HIV-infected persons with scabies have coexistent S. aureus folliculitis. Treatment of cutaneous staphylococcal lesions Very superficial lesions, like bullous impetigo, often respond to an antistaphylococcal antibiotic, such as dicloxacillin (500 mg given PO qid) or 7-10 days. Combinations of antibiotics. Washing the infected area once daily or every other day with an antibacterial agent (Hibiclens, Betadine) helps

88. The Teaching File Case #3 B. quintana causes bacillary angiomatosis which is rare cutaneous infection, manifestingmicorvascular proliferation, seen primarily in HIV+ individuals. http://www.uab.edu/pedradpath/case3.html

Radiology-Pathology Teaching File Case #3 Large Intracranial Mass Clinical Information: This 19-year-old white male with a known seizure disorder presents with a two month history of frontal headaches, dizziness and worsening seizures. School performance has diminished and he has dysarthria, left sided weakness and blurred vision. On physical exam he has left sided paresis, left facial nerve palsy and blurring of the left optic disk. CT+ T1+Gd T1+Gd T1+Gd C+ Head CT and T2(FSE), T1+Gd MRI: Unenhanced CT images (not shown) reveal no evidence for calcification nor hemorrhage. Enhanced CT and MR are shown: there is a large, poorly demarcated lesion centered near the right basal ganglia/thalamus with primary extension into right temporal lobe causing considerable edema, mass effect and midline shift to the left. There is infiltration of the hypothalamus, midbrain and meninges. Deep within its center the lesion shows an unusual, punctate or lacunar enhancement pattern on both CT and MR. E. F. G.

89. Bazilläre Angiomatose Translate this page bacillary angiomatosis a newly characterized, pseudoneoplastic, infectious,cutaneous vascular disorder. J Am Acad Dermatol 1990, 22501-12. http://hiv.net/2010/buch/oi/angio.htm

Home HIV Medicine Geschichte Wer ? ... zu HIV.NET 2003 von Christian Hoffmann 365-Tage-Literatur http://hiv.net/link.php?id=11 ). Sie kommt, wenngleich selten, auch hierzulande vor und ist bei allen unklaren Hauteffloreszenzen eine wichtige Differentialdiagnose. Die pseudoneoplastischen, vaskulären Haut-Proliferationen werden klinisch (und histologisch!) sehr oft mit Kaposi-Sarkomen oder auch Hämangiomen verwechselt. Verursacht wird die bazilläre Angiomatose durch die beiden Rickettsien-Spezies Bartonella henselae und Bartonella quintana (bis Anfang der 90er Jahre noch "Rochalimaea"). Katzen sind der Hauptwirt für Bartonella henselae, Katzenflöhe der Vektor. Bei Bartonella quintana erkranken häufig Patienten aus sozial schwachen Verhältnissen, insbesondere Obdachlose. Hier werden verschiedene Erregerreservoire diskutiert (Gasquet et al. 1998). http://hiv.net/link.php?id=12 Literatur Cockerell CJ, LeBoit PE. Bacillary angiomatosis: a newly characterized, pseudoneoplastic, infectious, cutaneous vascular disorder. J Am Acad Dermatol 1990, 22:501-12. http://amedeo.com/lit.php?id=2179301

90. Bacillary Angiomatosis Dermatology Dictionary B bacillary angiomatosis. bacillary angiomatosis is anexuberant proliferation of granulation tissue caused by Bartonella henselae. http://skincareguide.com/content/page.asp?a=590

91. Australasian Society For HIV Medecine MAY 1993, VOLUME 2, NO. 5 bacillary angiomatosis AND AIDS Isolation of Rochalimaeaspecies from cutaneous and osseous lesions of bacillary angiomatosis. http://www.ashm.org.au/index.php?SD=10&DExpand=1&PageCode=1027

92. BARTENELLA BARTONELLA (1387529). Synonyms Tick Borne Diseases, bacillary angiomatosisbacteremia, trench Fever. CPT 4 CODE 87529. Test Order Mnemonic BART PCR. http://www.utmb.edu/lsg/LabSurvivalGuide/mol_diag/BARTENELLA.html

A B C D ... LSG Home BARTONELLA (138-7529) Synonyms: Tick Borne Diseases, Bacillary angiomatosis bacteremia, trench Fever CPT 4 CODE: Test Order Mnemonic: BART PCR Applies to: Presence of circulating Bartonella Lab: Molecular Diagnostic Laboratory Request Form: Must be manually written on any of the available Laboratory Request Forms Collection: Routine Venipuncture, aseptically collected CSF or other body fluid Storage Instructions: Refrigerate whole blood, CSF, aseptically collected body fluids Causes for Rejection: Serum, heparin collection tube Availability: Special Instructions: Do not Centrifuge or separate specimen Specimen: Whole blood with EDTA (purple) or Sodium Citrate (blue), CSF, Amniotic fluid, other aseptically collected body fluids with laboratory approval Volume: 5 mls. Minimum Volume: 1 ml Container: EDTA (purple) or sodium citrate (blue), sterile collection container Reviewed by Dr. Payne/ S. Seifert 2/00 A B C D ... Statewide Search This site published by Janet L. Vincent for Department of Pathology Patient Services. The University of Texas Medical Branch Please review our and Internet guideline

93. Nodules And Plaques In Patient With AIDS Differentiating between bacillary angiomatosis andKaposi´s sarcoma can be extremely challenging. http://www.medscape.com/viewarticle/410247

94. PharmGKB: Angiomatosis, Bacillary Epithelioid; Angiomatosis, Bacillary Epithelioid; Angiomatosis, Epithelioid; BacillaryAngiomatoses; bacillary angiomatosis; Bacillary Epithelioid Angiomatoses http://www.pharmgkb.org/do/serve?objId=PA446418&objCls=Disease

95. First World War Disease Has Come Back To Threaten Homeless AIDS the University of CaliforniaSan Francisco, who set out to identify the microbesresponsible for a chronic, relapsing infection called bacillary angiomatosis. http://www.pslgroup.com/dg/4f696.htm

96. Methods And Compositions For Diagnosing Cat Scratch Disease And Printable Version. Methods and Compositions for Diagnosing Cat Scratch Diseaseand bacillary angiomatosis Caused by Rochalimaea henselae. FLC Locator. http://www.federallabs.org/servlet/TechDetailServlet?LinkCoArID=1999-03-30-10-21

97. Clin-Path Associates, P.C. - December 2000 Newsletter B. henselae causes cat scratch disease in immunocompetent persons, or bacillaryangiomatosis and peliosis in patients with defective cellular immunity. http://www.clin-path.com/html/newsletters/dec2000.html

December 2000 Newsletter PSA Consult Volume III No. 10 December 31, 2000 LABORATORY DIAGNOSIS OF BARTONELLA INFECTION Clinical Bartonella Syndromes Cutaneous bacillary angiomatosis (BA) Extracutaneous BA Bacillary peliosis hepatis and splenis Cat scratch disease Trench fever Bacteremia and endocarditis - Acute; Oroya fever - Chronic; verruga peruana Clinical Features The severity and presentation is related to the immune status. In general, classical CSD occurs in otherwise healthy patients, whereas those immunocompromised by AIDS or immunosuppression tend to have systemic disease characterized by bacillary angiomatosis. However, systemic disease has been reported in healthy patients and cat scratch disease in AIDS patients. Cat Scratch Disease typically presents clinically as regional lymphadenopathy preceded by an erythematous papule at the inoculation site in 25-95% of patients. These two findings plus positive serology and characteristic histopathologic features are keys to the diagnosis. About two weeks after the scratch, regional lymphadenopathy develops, which lasts two-four weeks and resolves spontaneously. For most patients this is the typical course, but in 1-2% of cases there is prolonged morbidity with persistent fever, expanding suppuration of nodes with rupture through the capsule and extension to the skin. Other complications include Parinauds ocularglandular syndrome, hepatic and splenic abscess, encephalopathy, pneumonia, arthralgia and various skin eruptions.

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