We report on two homeless, HIV-infected patients with 
intravenous drug abuse developing a generalized rash 
composed of angiomatous papules. Based on the clinical 
manifestations, routine histology and sequencing of 
bacterial 
16S rRNA the diagnosis of bacillary 
angiomatosis (BA) was established. In addition to treating 
the underlying HIV infection, the patients received 
azithromycin leading to complete regression of the 
cutaneous lesions.  
These cases highlight the clinical efficacy of azithromycin 
in the treatment of bacillary angiomatosis. Compared to 
the first line treatment of BA with erythromycin, 
azithromycin has a better tolerability, shows a more 
favorable drug-drug interaction profile and, most 
importantly, can be given once daily due to its superior 
pharmacological properties. Collectively, azithromycin 
poses an attractive alternative in the treatment of BA, 
especially in patient populations with low treatment 
adherence.