Eruptive Angiomas Maximilian C. Aichelburg 9th EACS Advanced HIV Course 7-9 September 2011...
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Transcript of Eruptive Angiomas Maximilian C. Aichelburg 9th EACS Advanced HIV Course 7-9 September 2011...
Eruptive Angiomas
Maximilian C. Aichelburg
9th EACS Advanced HIV Course7-9 September 2011
Aix-en-ProvenceFrance
25-year old patient HIV-1 infection
– known since 02/2007– IDU– CD4+ T cells: 2/µl– HIV-1 RNA: 707946 copies/ml– ART naïve
Chronic Hepatitis C infection Homeless Malnutrition (BMI=17)
Anamnesis
Bacillary angiomatosis Rickettsiosis Kaposi sarcoma Granulomata pyogenica Eruptive senile angiomas Pityriasis lichenoides et varioliformis acuta (PLEVA) Verruga peruana
Scurvy M. Fabry M. Rendu-Osler Leukocytoclastic vaskulitis Syphilis II
Differential diagnoses
CRP 0,6 mg/dl (< 1) Moderate panzytopenia HHV-8 PCR: negative Syphilis-serology: not reactive
Laboratory findings
Warthin-Starry Staining
Bartonella quintana
16S ribosomal RNA sequence analysis from lesional skin
Identification of causative microbe
BACILLARY ANGIOMATOSIS
Diagnosis
Ultrasound:
reactive axillary and nuchal lymphadenopathy no hepatosplenomegaly
Echocardiography:
unremarkable CT (Cranium, Thorax, Abdomen):
no destruction of bone structures Eye examination:
no lesions
Medical check-up
Azithromycin 500mg once daily p. o.– Prophylaxis against atypical mycobacteria– Once daily-administration
ART: Tenofovir/Emtricitabin + Darunavir/r PCP-prophylaxis:
Sulfamethoxazole/Trimethoprim
Therapy
Bacillary Angiomatosis
Systemic infection caused by Bart. henselae (contact with cats) or quintana (homelessness; lice)
Immunocompromised patients (HIV/AIDS) correlation between number of lesions and severity of
immunosuppression
• Rash (84%), fever (62%), lymphadenopathy (45%), weight loss (35%), liver/spleen (32%), bone (16%), CNS (8%)
Gasquet et al, 1998. AIDS 12: 1793-1803
Pathogenesis
Dehio, Curr. Opin. in Microbiol., 2003 Minnick, Future Microbiol., 2009