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Organ Manifestation Diagnostic Approach Skin Diverse presentations: may resemble Kaposi sarcoma angiomatous nodule friable vascular lesion red papule pedunculated lesion deep subcutaneous mass Biopsy with Warthin-Starry staining (W-S) Bone extremely painful osteolysis lytic lesions on x-ray (technetium +) Biopsy with W-S Lymph node enlargement Biopsy with W-S Heart valve vegetation valve insufficiency Blood culture (lysis-centrifugation) Blood thrombosis, fever Blood culture (echo) Liver/spleen hypodense lesions-CT hepatosplenomegaly-CT elevated LFTs (alk. phos.) pancytopenia thrombocytopenia Biopsy with W-S (monitor for bleeding) Other brain, gastrointestinal, pulmonary, etc. Biopsy with W-S

Reprinted with permission from Koehler J. Recurrent bacterial infections: bartonella. Clinical Care Options for HIV 1995; 1(3):17-18.