British Journal of Dermatology 1995; 132: 113-115. Bacillary angiomatosis with cutaneous and oral lesions in an HIV-infected patient from the U.K. N.J.LEVELL, A.P.BEWLEY, S.CHOPRA, D.CHURCHILL.* P.FRENCH,t R.MILLER* AND J.J.H.GILKES Departments of Dermatology. 'Medicine and ^Genitourinary Medicine. Umversity College London Medical School London WIN 8AA, U.K. Accepted for publication 3 May 1994 Summary We describe an HIV positive patient with histologicaily confirmed cutaneous and oral lesions of bacillary angiomatosis, an unusual clinical presentation. As far as we are aware, this is the first reported case of cutaneous bacillary angiomatosis in the U.K. Case report A 28-year-old man was found to be HIV-1 antibody positive in 1987. He presented in May 1993 with a 6- week history of a purple nodule on his right index finger. He had a 6-month history of facial molluscum contagiosum, treated with intermittent cryotherapy, and had oral candidiasis of varying severity for 2 years, treated with oral fiuconazole 200 mg daily. The AIDS defining diagnosis of oesophageal candidiasis was made in lanuary 1993. He was also taking co-trimox- azole (trimethoprim/sulphamethoxazole) 960 mg daily, as prophylaxis against Pneumocystis pneumonia. He had taken zidovudine for 2 years, until April 1993, when this was discontinued because of anaemia. Examination revealed an 8-mm-diameter, purple, non-tender, spongy mass at the base of the right index finger (Fig. 1), with a narrow collarette of normal skin around the base. He also had multiple facial lesions of molluscum contagiosum. The clinical differential diag- nosis was pyogenic granuloma, Kaposi's sarcoma or bacillary angiomatosis. The lesion was curretted under local anaesthesia, and samples were sent for histological and microbiological examination. Initially, the lesion was thought histologicaily to be Kaposi's sarcoma. Bacterial, fungal and viral cultures were negative. Liver function tests were normal. Two weeks later the patient was admitted to hospital with malaise, sore throat and stabbing chest pains, and investigations revealed that he had sinusitis. On admis- sion, he was pyrexial (40°C), and he remained so despite treatment for sinusitis with oral erythromycin. Numerous additional cutaneous lesions developed over a period of Presented at the Section of Dermatology. The Royal Society of Medicine. London. October 1993, 2 days. These were situated on the arms and legs, and were of varied morphology: deep, tender, red/purple, dermal nodules with little epidermal change, measuring l - 2 c m in diameter; superficial, pink papules 2-4mm in diameter; larger, superficial purple papules 5-8 mm in diameter, with a surrounding diffuse erythematous macular halo. There was a smooth, purple. 3 mm- diameter papule on the inner left lower lip (Fig. 2). The cfinical diagnosis was of bacillary angiomatosis. On direct questioning, the patient recollected that he had been bitten by a friend's cat a year previously. Multiple biopsies of the different lesions were taken, and tissue was sent for histological and microbiological examination. When incised, yellow pus exuded from two deep, purple lesions. Histological examination supported the cfinical diagnosis of bacillary angiomatosis. Within the dermis there were multiple amorphous organisms which stained positively with Warthin-Starry silver stain (Fig. 3). All biopsy specimens showed a neutrophil infiltrate around multiple endothelial cells with promi- nent cytoplasm, within the dermis (Fig. 4). Review of the histology from the original digital lesion confirmed that this was also bacillary angiomatosis. Abdominal ultra- sound and CT scanning, cranial MRl scanning, upper gastrointestinal endoscopy, and radiographs of the legs, did not show any evidence of systemic involvement. While awaiting the results of the skin biopsies, he was treated in hospital, for severe sinusitis, with oral erythro- mycin base 500 mg twice daily for 3 days, and then intravenous ceftazidime 2 g three times daily. The cefta- zidime produced resolution of his fever, and a marked reduction in the size of the cutaneous lesions. After 5 days' treatment, he was discharged home, taking oral cipro- fioxacin 500 mg twice daily and penicillin V 500 mg four times daily. However, 7 days later, further superficial. 113