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Case report 865. Bacillary angiomatosis
K N Standiford1, C D Emery, R J Schiffman
1Department of Radiology, Pennsylvania Hospital, Philadelphia 19107.
Skeletal Radiology
|October 1, 1994
Summary
Bacillary angiomatosis can present with periostitis in patients with acquired immunodeficiency syndrome (AIDS). Deep skin biopsy is crucial for diagnosing this condition when initial tests are inconclusive.
Area of Science:
- Infectious Diseases
- Dermatology
- Radiology
Background:
- Bacillary angiomatosis (BA) is an opportunistic infection common in immunocompromised individuals, particularly those with acquired immunodeficiency syndrome (AIDS).
- Clinical presentation of BA can be diverse, often involving skin and subcutaneous tissues, but can also present with systemic symptoms.
- Periostitis, an inflammation of the bone's outer layer, is an unusual but significant finding in BA cases.
Observation:
- A case of bacillary angiomatosis is presented with subcutaneous lesions, systemic symptoms, and notable periostitis.
- The periostitis was extensive, initially obscuring a small cortical lytic lesion on imaging.
- The patient had a history of acquired immunodeficiency syndrome (AIDS), a key factor in the differential diagnosis.
Findings:
- Periostitis in an AIDS patient with skin lesions should raise strong suspicion for bacillary angiomatosis.
- Initial punch biopsies may not be sufficient for diagnosis.
- Deep surgical biopsy, including subcutaneous tissue, is recommended for definitive diagnosis when initial biopsies are unrevealing.
Implications:
- Early consideration of bacillary angiomatosis in AIDS patients presenting with periostitis and skin lesions is critical for timely diagnosis and treatment.
- Diagnostic protocols for suspected bacillary angiomatosis should include consideration for deep tissue biopsy.
- Recognizing the varied presentations of bacillary angiomatosis, including osseous involvement, improves patient outcomes.