Bacillary angiomatosis (BA) is caused by Bartonella henselae or Bartonella quintana reported to be acquired from cats or by trauma. A 40-year-old widow presented with a single large painful tumor over the left index finger at the site of a goat bite. With the history of goat bite, rapid increase in size, a uniformly soft purplish lobulated tumor, which bled on touch, and histopathology demonstrating proliferation of capillary-sized vessels, in the background of HIV infection, the differential diagnosis was narrowed down to BA and giant pyogenic granuloma (PG). All clinical diagnoses cannot be evidence based all the time, especially in resource-poor settings. Therapeutic trials are well-known in dermatology and the positive result needs to be considered as evidence for diagnosis in those situations. The remarkable clinical response to oral doxycycline, we feel, could be considered diagnostic of Bartonella infection, and hence, we report this case. Key messages: All clinical diagnoses cannot be evidence based all the time, especially in resource-poor settings. Therapeutic trials are well-known in dermatology. The positive result needs to be considered as evidence for diagnosis sometimes. The remarkable response to oral doxycycline of this goat bite incited skin lesion in our HIV-positive patient, we feel, could be considered diagnostic of Bartonella infection.