Bacillary angiomatosis with cytomegaloviral and mycobacterial infections of the palpebral conjunctiva in a patient with AIDS.

We report the clinical and histopathologic findings of bacillary angiomatosis involving the palpebral conjunctiva with concomitant infection by cytomegalovirus and Mycobacterium species in a patient with acquired immune deficiency syndrome. After debulking, the conjunctival tissue was studied with the use of light and electron microscopy; stains for bacteria, acid-fast bacilli, and Bartonella species; and immunohistochemical studies for cytomegalovirus and herpes simplex virus. We observed the typical histopathologic findings of bacillary angiomatosis, the presence of bacilli stained by the Steiner and Steiner method, and the electron microscopic demonstration of bacilli consistent with Bartonella species. Immunohistochemistry confirmed infection with cytomegalovirus, which had been suggested by characteristic cytologic abnormalities. Acid-fast bacilli were also found in the excised tissue. Patients with bacillary angiomatosis of the conjunctiva may have infections with multiple additional microorganisms.