A 52-year old male homosexual patient with acquired immunodeficiency s
yndrome (AIDS) presented in our clinic with multiple nodular papules (
more than 100) spread over the whole body which had developed within 3
months. Bacillary angiomatosis was suspected, which is a bacterial in
fectious disease recognized recently mainly in patients with AIDS. His
tological and immunohistochemical examinations of extirpated skin lesi
ons were in agreement with the diagnosis, and the detection of rod-sha
ped bacteria in the lesions by Warthin-Starry silver stain confirmed i
t. The patient was treated with 2x100 mg doxycycline per day. The feve
r disappeared, and the cutaneous lesions showed a slight tendency to i
mprove. However, after 5 days of therapy the patient showed increasing
weakness, with muscle and bone pain. The patient died 10 days after t
he doxycyline therapy had been started. The cutaneous lesions in bacil
lary angiomatosis may resemble Kaposi's sarcoma and may therefore be m
isdiagnosed. The disease may be fatal, but timely antibiotic treatment
is usually effective; therefore the diagnosis of bacillary angiomatos
is is important. Although many cases have been reported from the Unite
d States, only one case is known from Europe. Our finding of bacillary
angiomatosis in a German AIDS patient supports the concept of a world
wide distribution of this bacterial agent.