Successful treatment of bacillary angiomatosis with oral doxycycline in an HIV-infected child with skin lesions mimicking Kaposi sarcoma

ART: antiretroviral therapy BA: bacillary angiomatosis HHV-8: human herpes virus 8 KS: Kaposi sarcoma CASE REPORT A 12-year-old boy presented for treatment of widespread papules and fungating, ulcerating nodules (Fig 1). Seven months before referral, HIV was diagnosed, and he started antiretroviral therapy (ART), with a baseline CD4 count of 76 cells per microliter (5%). Per history, the rash began 1 month after ART initiation and progressively worsened in the 6 months after ART therapy started. The patient was referred to the Baylor Tanzania Center of Excellence in Mbeya, Tanzania because of concern of possible Kaposi sarcoma (KS). A skin biopsy was performed. The patient underwent chest radiography, abdominal ultrasound scan, and liver/renal function tests, the results of which were normal. A complete blood count was notable for severe anemia (hemoglobin level of 4.0 g/dL) requiring blood transfusion. The clinical diagnosis of bacillary angiomatosis (BA) was favored, and the patient was prescribed doxycycline, 100 mg twice daily. Although KS was also in the clinical differential diagnosis, chemotherapy was withheld pending biopsy results. Histologically, the lesion biopsy result was consistent with BA, and bacilli were observed with Warthin-Starry staining. At the 1-week follow-up appointment, a dramatic improvement in the appearance of the lesions was noted (Fig 2). The patient continued doxycycline with continued improvement over 7 additional weeks, with near complete resolution of the sores and lesions (Fig 3).