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Figure 1. A solitary angiomatous nodule (verruga peruana) was found on the forearm of a 24-year-old resident of the Peruvian Andes. Bartonella bacilliformis, which is transmitted by sandflies, was isolated from the lesion. The patient had no other symptoms and no preceding febrile episode, but did recall being bitten by sandflies in the past. After a two-week course of chloramphenicol, the lesion disappeared. Outbreaks of bartonellosis occur sporadically in the Andean region. Virtually identical angiomatous lesions (bacillary angiomatosis) are seen in patients with the acquired immunodeficiency syndrome and are caused by the genetically related B. henselae.
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