Bacillary angiomatosis in a solid organ transplant recipient

We report a case of bacillary angiomatosis in a solid organ transplant recipient with typical skin lesions. Bacillary angiomatosis is an uncommon disease characterized by neovascular proliferation caused by infection with Bartonella henselae or Bartonella quintana. Bacillary angiomatosis was first described in patients with HIV and CD4 cell counts <100/μL, but also occur in patients with other causes of immune deficiency. The disease usually manifests as skin tumors, and may involve other organs, most commonly the spleen and liver, known as peliosis. The involvement of internal organs can lead to fatal disease. Diagnosis is based on histology, culture, PCR and serology. The optimal antibiotic regimen and treatment duration for bacillary angiomatosis has not been established. Most authors recommend prolonged treatment (usually 12 weeks) of doxycycline or macrolide with addition of rifampicin or gentamycin for patients with severe disease. Recurrence after treatment is not rare. Suppressive therapy may be considered for patients with relapse after 12 weeks of therapy and continuous immunosuppression.