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Upper gastrointestinal bacillary angiomatosis causing hematemesis: a case report
1Department of Pathology, Nelson R Mandela School of Medicine, University of Natal, Durban, South Africa.
International Journal of Surgical Pathology
|August 2, 2003
Summary
Massive upper gastrointestinal bleeding in an HIV-positive patient was caused by bacillary angiomatosis affecting multiple gastrointestinal sites. This case highlights visceral bacillary angiomatosis without skin lesions.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pathology
Background:
- Human Immunodeficiency Virus (HIV) infection can predispose individuals to opportunistic infections.
- Bacillary angiomatosis (BA) is a bacterial infection typically affecting the skin and lymph nodes of immunocompromised individuals, particularly those with HIV/AIDS.
- Gastrointestinal involvement in BA is rare, especially presenting as massive hemorrhage without cutaneous manifestations.
Observation:
- A 38-year-old HIV-positive woman presented with severe upper gastrointestinal bleeding (hematemesis).
- Endoscopic examination revealed ulcerated, nodular lesions throughout the esophagus, stomach, and duodenum.
- Histopathological analysis of gastric biopsies showed features consistent with bacillary angiomatosis, including vascular proliferation and specific bacterial colonies identified by Warthin-Starry stain.
Findings:
- The patient's massive hematemesis was attributed to multifocal gastrointestinal bacillary angiomatosis.
- The diagnosis of bacillary angiomatosis was confirmed histopathologically, despite the absence of typical skin lesions.
- This case underscores the potential for visceral BA to manifest solely within the gastrointestinal tract.
Implications:
- This case expands the known spectrum of bacillary angiomatosis presentation in HIV-positive individuals.
- It emphasizes the importance of considering BA in the differential diagnosis of upper gastrointestinal hemorrhage in immunocompromised patients.
- Early recognition and appropriate antibiotic treatment are crucial for managing BA and preventing life-threatening complications like massive bleeding.