101
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Affiliation(s)
- K L Herman
- Department of Dermatology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19105
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102
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Relman DA, Loutit JS, Schmidt TM, Falkow S, Tompkins LS. The agent of bacillary angiomatosis. An approach to the identification of uncultured pathogens. N Engl J Med 1990; 323:1573-80. [PMID: 2233945 DOI: 10.1056/nejm199012063232301] [Citation(s) in RCA: 591] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Bacillary angiomatosis is an infectious disease causing proliferation of small blood vessels in the skin and visceral organs of patients with human immunodeficiency virus infection and other immunocompromised hosts. The agent is often visualized in tissue sections of lesions with Warthin-Starry staining, but the bacillus has not been successfully cultured or identified. This bacillus may also cause cat scratch disease. METHODS In attempting to identify this organism, we used the polymerase chain reaction. We used oligonucleotide primers complementary to the 16S ribosomal RNA genes of eubacteria to amplify 16S ribosomal gene fragments directly from tissue samples of bacillary angiomatosis. The DNA sequence of these fragments was determined and analyzed for phylogenetic relatedness to other known organisms. Normal tissues were studied in parallel. RESULTS Tissue from three unrelated patients with bacillary angiomatosis yielded a unique 16S gene sequence. A sequence obtained from a fourth patient with bacillary angiomatosis differed from the sequence found in the other three patients at only 4 of 241 base positions. No related 16S gene fragment was detected in the normal tissues. These 16S sequences associated with bacillary angiomatosis belong to a previously uncharacterized microorganism, most closely related to Rochalimaea quintana. CONCLUSIONS The cause of bacillary angiomatosis is a previously uncharacterized rickettsia-like organism, closely related to R. quintana. This method for the identification of an uncultured pathogen may be applicable to other infectious diseases of unknown cause.
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Affiliation(s)
- D A Relman
- Department of Microbiology and Immunology, Stanford University, Calif
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103
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Perkocha LA, Geaghan SM, Yen TS, Nishimura SL, Chan SP, Garcia-Kennedy R, Honda G, Stoloff AC, Klein HZ, Goldman RL. Clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus infection. N Engl J Med 1990; 323:1581-6. [PMID: 2233946 DOI: 10.1056/nejm199012063232302] [Citation(s) in RCA: 221] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Peliosis hepatis is characterized by cystic, blood-filled spaces in the liver and is seen in patients with chronic infections or advanced cancer and as a consequence of therapy with anabolic steroids. Cutaneous bacillary angiomatosis is a bacterial infection that occurs in patients with human immunodeficiency virus (HIV) infection; its histologic appearance is that of a pseudoneoplastic vascular proliferation. METHODS We studied liver tissue from eight HIV-infected patients with peliosis hepatis, two of whom also had cutaneous bacillary angiomatosis. For comparison we examined tissue from four patients who had peliosis hepatis without HIV infection. Tissues were examined histologically on routine sections and with special stains and electron microscopy. RESULTS The histologic features seen in peliosis hepatis associated with HIV infection, but not in the four cases unrelated to HIV infection, were myxoid stroma and clumps of a granular purple material that on Warthin-Starry staining and electron microscopy proved to be bacilli. The bacilli, which could not be cultured, were morphologically identical to those found in the skin lesions of cutaneous bacillary angiomatosis. The clinical courses of two of the patients with this "bacillary peliosis hepatis" indicate that it responds to antibiotic treatment. CONCLUSIONS HIV-associated bacillary peliosis hepatis is an unusual, treatable opportunistic infection, probably caused by the same organism that causes cutaneous bacillary angiomatosis. Our failure to find bacilli in non-HIV-associated cases implies that other pathogenetic mechanisms may also be responsible for peliosis hepatis.
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Affiliation(s)
- L A Perkocha
- Department of Pathology, University of California, San Francisco
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104
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Krekorian TD, Radner AB, Alcorn JM, Haghighi P, Fang FC. Biliary obstruction caused by epithelioid angiomatosis in a patient with AIDS. Am J Med 1990; 89:820-2. [PMID: 2252053 DOI: 10.1016/0002-9343(90)90231-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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105
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Affiliation(s)
- P D Welsby
- Department of Infectious Diseases, City Hospital, Edinburgh, UK
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106
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Kemper CA, Lombard CM, Deresinski SC, Tompkins LS. Visceral bacillary epithelioid angiomatosis: possible manifestations of disseminated cat scratch disease in the immunocompromised host: a report of two cases. Am J Med 1990; 89:216-22. [PMID: 2382668 DOI: 10.1016/0002-9343(90)90301-s] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Opportunistic infection with the causative agent of cat scratch disease may be responsible for an unusual vascular proliferative lesion, referred to as bacillary epithelioid angiomatosis, previously described only in human immunodeficiency virus (HIV)-infected patients. We present a case of an HIV-infected patient with bacillary epithelioid angiomatosis involving the liver and bone marrow causing progressive hepatic failure. We also report a case of a cardiac transplant recipient with hepatic and splenic bacillary epithelioid angiomatosis manifesting as a fever of unknown origin, a previously unreported event in a non-HIV-infected patient. These cases represent the first documentation of bacillary epithelioid angiomatosis with visualization of cat scratch-like organisms involving internal organs.
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Affiliation(s)
- C A Kemper
- Department of Medicine, Stanford University School of Medicine, California
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107
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Mui BS, Mulligan ME, George WL. Response of HIV-associated disseminated cat scratch disease to treatment with doxycycline. Am J Med 1990; 89:229-31. [PMID: 2382670 DOI: 10.1016/0002-9343(90)90303-u] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- B S Mui
- Medical Service, West Los Angeles Veterans Administration Medical Center, California 90073
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108
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Szaniawski WK, Don PC, Bitterman SR, Schachner JR. Epithelioid angiomatosis in patients with AIDS. Report of seven cases and review of the literature. J Am Acad Dermatol 1990; 23:41-8. [PMID: 2195074 DOI: 10.1016/0190-9622(90)70183-i] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Seven cases of a distinctive vascular proliferation in patients with acquired immunodeficiency syndrome are discussed and compared with other reported cases. All cases share clinical and pathologic manifestations that can be recognized early. Warthin-Starry-positive bacilli within some of the lesions and their response to erythromycin may indicate that the proliferation is associated with an infectious agent, possibly the bacillus that causes cat-scratch disease.
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109
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Abstract
A patient with human immunodeficiency virus infection presented with a soft-tissue mass which histologically and clinically mimicked an angiosarcoma. Ultrastructural study, however, revealed bacteria identical to those seen in cutaneous bacillary angiomatosis, but the patient had no skin lesions. To our knowledge, this represents the first report of soft tissue involvement by bacillary angiomatosis without the presence of skin lesions.
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Affiliation(s)
- R A Schinella
- Department of Pathology, Bellevue Hospital, New York University School of Medicine, NY
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110
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Cockerell CJ, LeBoit PE. Bacillary angiomatosis: a newly characterized, pseudoneoplastic, infectious, cutaneous vascular disorder. J Am Acad Dermatol 1990; 22:501-12. [PMID: 2179301 DOI: 10.1016/0190-9622(90)70071-o] [Citation(s) in RCA: 117] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Bacillary angiomatosis (also called epithelioid angiomatosis) is a newly recognized disease most often characterized by a cutaneous infection with reddish papules of vascular origin. It is caused by a weakly reactive gram-negative bacillus, which can be easily demonstrated in tissue sections with the Warthin-Starry stain. Bacillary angiomatosis usually responds readily to treatment with oral erythromycin, 250 to 500 mg, taken four times a day for 2 weeks to 1 month. Because the skin is the most common site of involvement, it is important that the dermatologist recognize this unusual condition. It is essential that treatment be started as soon as possible because deaths may result from visceral and mucosal involvement. The clinical, histologic, and microbiologic aspects of bacillary angiomatosis are discussed and depicted in detail and speculations regarding the pathogenesis are rendered.
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Affiliation(s)
- C J Cockerell
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas 75235-9072
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111
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Abstract
Cat-scratch disease (CSD) is a common cause of chronic lymphadenopathy (especially regional) that primarily affects children and adolescents. The clinical diagnosis of CSD is based on the presence of three of four criteria, which may include a positive CSD skin test. Usually a benign, self-limiting disease, CSD may sometimes have atypical manifestations and serious complications, particularly in immunocompromised hosts. Cat-scratch disease is now known to be caused by a small, gram-negative, pleomorphic bacterium. Antibiotics are dramatically effective against CSD in immunocompromised patients, but are not [corrected] of proven benefit in typical cases. Most patients recover with only symptomatic treatment. This article reviews the history of CSD research, clinical features of typical and atypical CSD, and current topics of interest in CSD research, especially in the areas of diagnosis and treatment.
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Affiliation(s)
- E A Shinall
- Department of Pediatrics, Boston Floating Hospital for Infants and Children, New England Medical Center, MA 02111
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112
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Jimenez-Acosta F, Pardo RJ, Cohen RJ, Gould EW, Penneys NS. Bacillary angiomatosis of acquired immunodeficiency syndrome: case report and literature review. J Am Acad Dermatol 1990; 22:525-9. [PMID: 2179302 DOI: 10.1016/s0190-9622(08)80400-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- F Jimenez-Acosta
- Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, FL 33101
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113
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Milam MW, Balerdi MJ, Toney JF, Foulis PR, Milam CP, Behnke RH. Epithelioid angiomatosis secondary to disseminated cat scratch disease involving the bone marrow and skin in a patient with acquired immune deficiency syndrome: a case report. Am J Med 1990; 88:180-3. [PMID: 2301445 DOI: 10.1016/0002-9343(90)90471-o] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- M W Milam
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa 33612
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114
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Schwartzman WA, Marchevsky A, Meyer RD. Epithelioid angiomatosis or cat scratch disease with splenic and hepatic abnormalities in AIDS: case report and review of the literature. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1990; 22:121-33. [PMID: 2192439 DOI: 10.3109/00365549009037892] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cat scratch disease (CSD) in the setting of HIV infection is associated with lesions of epithelioid angiomatosis but not with granulomatous lesions seen in the normal host. We report a case of CSD in a patient with AIDS and Kaposi's sarcoma with epithelioid angioma of skin, thrombocytopenia, and abnormalities of liver, spleen, lymph node, and pleura that responded to antimicrobial therapy. We also review reported cases of epithelioid angiomatosis in HIV infections. 12 of these resolved, including 3 without antimicrobial therapy; 18 demonstrated pleomorphic organisms with Warthin-Starry silver stain. Six involved visceral or bony as well as skin lesions. CSD should be considered in the setting of HIV infection with skin nodules even in the presence of biopsy-proven Kaposi's sarcoma. CSD may in these patients be responsible for a variety of disseminated lesions which respond to antimicrobial therapy.
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Affiliation(s)
- W A Schwartzman
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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115
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Walford N, Van der Wouw PA, Das PK, Ten Velden JJ, Hulsebosch HJ. Epithelioid angiomatosis in the acquired immunodeficiency syndrome: morphology and differential diagnosis. Histopathology 1990; 16:83-8. [PMID: 2307419 DOI: 10.1111/j.1365-2559.1990.tb01066.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A rare vascular proliferation found as a skin lesion in patients suffering from the acquired immunodeficiency syndrome and sometimes referred to as epithelioid angiomatosis is believed to be a manifestation of infection by the cat scratch bacillus or a related organism. We describe the histological findings from eight lesions seen in two cases. In all cases the diagnosis could be confirmed by demonstration within the lesions of groups of gram-negative rod-shaped organisms staining positively with the Warthin-Starry stain. This condition needs to be distinguished from a variety of reactive and neoplastic vascular proliferations.
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Affiliation(s)
- N Walford
- Department of Pathology, Academic Medical Centre of the University of Amsterdam, The Netherlands
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116
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Affiliation(s)
- M H Witte
- Department of Surgery, University of Arizona College of Medicine, Tucson 85724
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117
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Abstract
Several reports have recently appeared in the literature describing "unique" non-neoplastic vascular lesions in patients with the acquired immunodeficiency syndrome (AIDS). These lesions may be mistaken clinically and histologically for Kaposi's sarcoma. The terms epithelioid angiomatosis, epithelioid or histiocytoid hemangioma, and pyogenic granuloma have all been used to describe a similar entity in which cat scratch disease bacillus (CSDB) was subsequently identified. Lesions closely resembling this entity occur in patients with bartonellosis. We report a case of a cutaneous vascular lesion on the hand of an AIDS patient in which cytomegalovirus (CMV) and organisms consistent with CSDB were both found. Simultaneous infections with CMV and CSDB have not been previously described. The presence of these organisms in and around endothelial cells may provide the common stimulus for the formation of these reactive vascular proliferations.
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Affiliation(s)
- J Abrams
- Department of Pathology, Pennsylvania Hospital, Philadelphia
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118
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119
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Fine RM. Recent advances in medicine (1988). AIDS, HTLV 1, mycosis fungoides/Sezary syndrome, psoriasis, HPV, lupus, scleroderma, and cancer. Int J Dermatol 1989; 28:265-8. [PMID: 2656553 DOI: 10.1111/j.1365-4362.1989.tb04819.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- R M Fine
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
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120
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121
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Pindborg JJ. Classification of oral lesions associated with HIV infection. ORAL SURGERY, ORAL MEDICINE, AND ORAL PATHOLOGY 1989; 67:292-5. [PMID: 2648242 DOI: 10.1016/0030-4220(89)90358-7] [Citation(s) in RCA: 91] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This article proposes a classification for oral lesions associated with HIV infection. The lesions can be classified into those with fungal, bacterial, or viral origin whereas other subgroups include neoplasms, neurologic disturbances, and lesions of unknown cause. This proposal is neither final nor exhaustive and is forwarded as a basis for epidemiologic surveys.
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Affiliation(s)
- J J Pindborg
- Department of Oral Pathology, Royal Dental College, Copenhagen, Denmark
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122
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123
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Hall AV, Roberts CM, Maurice PD, McLean KA, Shousha S. Cat-scratch disease in patient with AIDS: atypical skin manifestation. Lancet 1988; 2:453-4. [PMID: 2900380 DOI: 10.1016/s0140-6736(88)90442-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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