CLINICAL AND PATHOLOGICAL FEATURES OF BACILLARY PELIOSIS HEPATIS IN ASSOCIATION WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

Peliosis hepatis is characterized by cystic, blood-filled spaces in the liver and is seen in patients with chronic infections or advanced cancer and as a consequence of therapy with anabolic steroids. Cutaneous bacillary angiomatosis is a bacterial infection that occurs in patients with human immunodeficiency virus (HIV) infection; its histologic appearance is that of a pseudoneoplastic vascular proliferation. We studied liver tissue from eight HIV-infected patients with peliosis hepatis, two of whom also had cutaneous bacillary angiomatosis. For comparison we examined tissue from four patients who had peliosis hepatis without HIV infection. Tissues were examined histologically on routine sections and with special stains and electron microscopy. The histologic features seen in peliosis hepatis associated with HIV infection, but not in the four cases unrelated to HIV infection, were myxoid stroma and clumps of a granular purple material that on Warthin—Starry staining and electron microscopy proved to be bacilli. The bacilli, which could not be cultured, were morphologically identical to those found in the skin lesions of cutaneous bacillary angiomatosis. The clinical courses of two of the patients with this “bacillary peliosis hepatis” indicate that it responds to antibiotic treatment. HIV-associated bacillary peliosis hepatis is an unusual, treatable opportunistic infection, probably caused by the same organism that causes cutaneous bacillary angiomatosis. Our failure to find bacilli in non-HIV-associated cases implies that other pathogenetic mechanisms may also be responsible for peliosis hepatis. PELIOSIS HEPATIS is a rare condition characterized by cystic, blood-filled spaces in hepatic parenchyma.1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Splenic peliosis has also been reported, either alone16 17 18 19 or with hepatic peliosis.2 3 4,10,11,19,20 Early cases of peliosis hepatis were seen in patients with wasting due to pulmonary tuberculosis or advanced cancer.1 2 3 4 Recently, anabolic steroids and other drugs have been implicated.5 6 7 8 9 10 11 12 13 14 15 Three reports describe peliosis hepatis in patients with human immunodeficiency virus (HIV) infection.21 22 23 We have seen two HIV-infected patients with peliosis hepatis who also had cutaneous bacillary angiomatosis, a recently described pseudoneoplastic vascular proliferation containing bacteria.24 25 26 27 28 29 30 31 32 33 Bacillary angiomatosis usually presents clinically as erythematous papules and nodules. On… © 1990, Massachusetts Medical Society. All rights reserved.