Bacillary angiomatosis. A "new" disease with a broadening clinicopathologic spectrum

Bacillary angiomatosis (BA) is a reactive vasoproliferative lesion occurring almost exclusively in immunocompromised individuals in response to infection by a bacillus closely related to Rochalimaea quintana. The commonest site of involvement is the skin, in the form of multiple erythematous nodules, but bacillary angiomatosis can also present in a wide variety of sites such as soft tissues, bone, lymph node, liver and spleen. Some patients may present with persistent fever and bacteraemia. Bacillary angiomatosis is characterized histologically by proliferation of blood vessels lined by plump endothelium, associated with an interstitial eosinophilic or amphophilic material formed by aggregated bacilli, best demonstrated by the Warthin-Starry stain. A heavy infiltrate of neutrophils is frequently, but not invariably, present. In the liver and spleen, there may be in addition features of peliosis. It is important to be able to diagnose bacillary angiomatosis correctly because prompt treatment with antibiotics is potentially life-saving.