A Case of AIDS Manifesting Pruritic Papular Eruptions and Psoriasiform Lesions: An Immunohistochemical Study of the Lesional Dermal Infiltrates

A 63-year-old man was referred to our department on September 14, 1992, because of multiple red papules with severe itching. Pruritic papular eruption (PPE) in a human immunodeficiency virus (HIV)-infected patient was diagnosed based on the histological findings, the reduction in CD4, and positive results for HIV antibody. In September of 1993, papules and erythematous plaques with scales appeared on both the palms and soles. The erythema was pruritic and spread gradually to the extremities and trunk. These plaques with erythema and scales are similar to those of the psoriatic lesions seen in Reiter's syndrome, although the HLA typing was not B27. Immunohistopathological findings of the papules of PPE and plaques of psoriasiform lesions showed that perivascularly infiltrated cells in the dermis were mostly lymphocytes. The lymphocytes in PPE were positive for CD45 and negative for CD3, CD43, and CD45RO, but the lymphocytes in psoriasiform lesions were positive for CD45, CD3, and CD43. Moreover, 20–30% of these lymphocytes were also intensely positive for CD45RO. These observations were similar to those obtained in the lesional skin of HIV-negative psoriasis, suggesting that there were no significant immunohistopathological differences in the abnormality of local cellular immunity related to the formation of psoriasiform lesions in HIV-negative psoriasis and HIV-positive psoriasis.     

以瘙痒性丘疹为首发症状的急性HIV感染2例

2例均为39岁的男性患者。例1全身泛发丘疹、结节,伴剧烈瘙痒3月,皮疹反复发作,进行性增多,治疗抵抗。例2面部、躯干及四肢泛发丘疹、结节和斑块,伴剧烈瘙痒2年,皮疹逐渐增多,部分丘疹顶部坏死,伴有少许糜烂、渗液及萎缩性瘢痕。2例患者血清HIV抗体初筛试验(ELISA法)及确诊试验(免疫印迹法)均(+)。诊断:急性HIV感染。     

Pruritic papular eruption associated with HIV-etiopathogenesis evaluated by clinical, immunohistochemical, and ultrastructural analysis

Pruritic Papular Eruption with Human Immunodeficiency Virus infection (PPE-HIV) is characterized by symmetrically distributed papules with pruritus in the skin of patients suffering advanced HIV infection. Although known since 1985, the etiology of this symptomatic dermatitis is unclear. We set out to characterize the phenotype of the infiltrating cells and the cytokine profile in the lesions, as an attempt to contribute to determining its etiopathogenesis. Clinical data and histological, immunohistochemical, and ultrastructural features of skin biopsies from 20 HIV patients with PPE were studied. The histopathological aspects, cell immunophenotypes, and cytokine expressions in the lesions where quantified and compared to perilesional skin, and to those in the clinically normal skin of HIV patients without PPE-HIV (n=11) and those in normal skin samples from HIV negative individuals (n=10). PPE-HIV occurred mainly in HIV patients with mean CD4+ counts of 124.6 +/- 104 lymphocytes/mm3. Furthermore, their eosinophil counts were significantly increased. The skin lesions were characterized by a predominantly perivascular dermal lymphohistiocytic inflammatory infiltrate. Langerhans cells were normally distributed in the epidermis and seen among the cellular components of dermal infiltrates. The density of CD8+ lymphocytes was elevated and the density of CD4+ cells was reduced in dermal infiltrates. Interleukin 5 was the predominant cytokine in the lesions. Electron microscopic analysis didn't disclose HIV or other infectious agents in the lesions. These results refute the hypothesis of an infectious etiology of PPE-HIV. CD8+ lymphocytes and Langerhans cells seem to have roles in the pathogenesis of PPE-HIV. The increased frequency of IL5 was associated with abundant eosinophils in the lesions, suggesting a type Th2 response in this dermatitis.     

HIV-Associated Eosinophilic Pustular Folliculitis: Successful Treatment of a Japanese Patient with UVB Phototherapy

We report the successful treatment with ultraviolet B phototherapy of a patient with HIV-associated eosinophilic pustular folliculitis. We were able to observe the clinical and therapeutic course for about one year and three months. This 35-year-old homosexual Japanese man presented with disseminated, discrete, follicular, erythematous papules with intense pruritus over his face, neck, chest wall, and upper back. Initially, the eruption responded to therapy with topical or oral indomethacin and oral H₁ antihistamine. However, the eruption was highly prone to recurrence, and it gradually failed to respond to these therapies. The eruption became chronic and persistent and manifested the excoriated, prurigo-like nodules that are typical of reported pruritic papular eruption, suggesting that this skin disease and HIV-associated eosinophilic pustular folliculitis are two forms of the same disease entity. UVB phototherapy in small doses was very effective for the persistent eruption, and no recurrence of the eruption was noted during or since the six-month maintenance therapy (once a week at a dose equivalent to 0.75 of the minimal erythema dose) (9 months total). No unfavorable side effects have been observed during or after the UVB phototherapy (cumulative UVB doses of 2,320 mJ/cm²).     

河南省农村HIV/AIDS患者HIV相关性痒疹调查

目的 了解河南省农村地区HIV/AIDS患者中艾滋病相关瘙痒性丘疹性皮疹(简称:HIV相关性痒疹)的患病情况及对HIV/AIDS患者的影响。方法 在河南省4个地区随机抽取8个艾滋病高发村(HIV≥20人),符合入选标准的163个HIV相关性痒疹病人整群纳入。使用流式细胞仪测定CD4细胞,WHO艾滋病生存质量量表(WHOQOL-HIV)和皮肤生活质量指数问卷(DLQI)评定患者生活质量,PPE临床表现量化表评价患者临床症状。结果 河南省农村HIV/AIDS中HIV相关性痒疹的时点患病率8.79%。HIV相关性痒疹患者中CD4≥200者占25.77%,CD4<200者占74.23%。女性HIV相关性痒疹的CD4细胞计数比男性高(P<0.05)。CD4<200的HIV相关性痒疹患者WHOQOL-HIV独立领域得分比CD4≥200的高(P<0.05)。PPE临床表现量化表与WHOQOL-HIV之间存在相关性。PPE临床表现量化表(皮损严重程度、皮损面积、瘙痒程度)呈正相关(P<0.05)。结论 多数HIV相关性痒疹患者免疫功能较差。不同性别HIV相关性痒疹患者免疫功能存在差异。HIV相关性痒疹临床表现(严重程度、面积、瘙痒程度)的差异性反应了生活质量不同领域的变化。     

Generalized Erythematous Skin Eruptions Due to Trimethoprim Itself and Co-Trimoxazole

A 20-year-old Japanese woman (Case 1) and a 70-year-old Japanese man (Case 2) consulted us with slight fever and disseminated erythematous papules. Examinations revealed that the first case was a skin eruption due to trimethoprim itself and the second was due to both trimethoprim and sulphamethoxazole. To our knowledge, our Case 1 is the first reported case with an erythematous papular type skin eruption caused by trimethoprim itself, and our Case 2 is the first case of a skin eruption in reaction to both trimethoprim and sulphamethoxazole.     

Ablative Carbon Dioxide Laser Treatment for Papular Scars of Nose and Chin Due to Acne: A Case Series

Introduction:Papular scarring of the nose and chin due to acne is an under-reported,under-recognized,and under-treated condition.Ablative carbon dioxide laser t...     

婚检发现HIV感染1例

江苏常州婚检人群检出首例HIV感染者。患者男,28岁,常州籍,工人。婚前常规体检:T36.4℃,无皮疹、淋巴结肿大、口腔溃疡;无皮肤瘙痒;无腹痛、腹胀、腹泻等不适;B超示肝、脾、肾未见异常;血常规、尿常规正常,丙氨酸氨基转移酶(ALT)正常、乙肝表面抗原(HBsAg)阴性,梅毒螺旋体抗体阴性,血液筛查和确证为HIV-1抗体阳性。流行病学调查为经性途径传播所致的无症状HIV感染者。建议在婚检中引入艾滋病筛查。     

昆明地区1766例STD门诊就诊者HIV感染状况

目的　了解近年来STD门诊就诊者HIV感染状况。方法　对 1998年～ 2 0 0 2年在本科STD门诊就诊的 1766例患者血液标本进行了抗HIV 2抗体的检测 ,用明胶颗粒凝集试验作初筛试验 ,蛋白印迹检测法作确证试验。结果　检出HIV阳性 16例 ,阳性率 0 .91% ;男女之比为 3∶1;年龄分布在 17～ 56岁之间 ;其中静脉吸毒 9例 ,性传播 5例 ,输血传播 1例 ,可能因使用消毒不合格注射器传播 1例 ;个体经营者及工人感染人数最多 ;文化程度以初中为主 ;HIV阳性者中合并梅毒 1例。结论　HIV感染正从静脉吸毒人群向一般人群传播     

婚检发现HIV感染5例分析

目的分析总结无锡市惠山区婚检发现HIV感染者的流行病学调查特点。方法 SPSS回顾性分析惠山区2008-2010年的婚检资料。结果共检测出5例血液筛查和确证均为HIV-1抗体阳性的病例。其中4例是性传播、1例是血制品传播所致的无症状HIV感染者。性传播的4例中3例是男男性行为者(MSM),1例为异性性传播。结论建议在婚检中引入HIV抗体筛查,有助于掌握疫情的流行趋势,从而采取相应有效的干预措施,控制HIV的传播。     

特比萘芬治疗外阴阴道念珠菌病的疗效观察

目的观察特比萘芬与伊曲康唑治疗外阴阴道假丝酵母菌病(念珠菌性外阴阴道炎)的疗效。方法选择本院妇科门诊诊断为外阴阴道假丝酵母菌病患者120例,随机分为治疗组和对照组各60例,分别予口服特比萘芬250mg、伊曲康唑200mg均1次/d,连服2周。结果治疗组和对照组有效率分别为81.7%和83.3%,差异无显著性(P=0.901);两组不良反应发生率差异亦无显著性(P>0.05)。结论口服特比萘芬治疗外阴阴道假丝酵母菌病疗效良好,不良反应少。     

Relation of allergy to HIV infection

In this retrospective study on 141 HIV-positive subjects, allergy was studied by a specific questionnaire and the Phadia-Top-Test, an in vitro screening test detecting specific IgE; both were correlated to the patient's history, clinical symptoms and the treatment used. Allergy was studied in reference to HIV-negative controls and in relation to the clinical and biological subgroups of HIV patients.
The application of the x² test demonstrated a high incidence of allergy and a specific relation to the HIV infection compared to the controls as well as in relation to the clinical stage of the infection. Atopy was not specifically related to the HIV infection despite the higher frequency found in the AIDS-IKEL group.
A significant number (21%) of patients with T4 > 300/μ1 considered immunocompetent presented clinical manifestations of AIDS-IKEL and 100% of these patients were allergic. A significant number (19%) of patients with T4 < 300/μ1 considered immunodeficient were asymptomatic and 75% of them were allergic.
Thus allergic symptoms may transiently be the only clinical manifestations in HIV infection and possibly a co-factor for the evolution of the disease due to the immunomodulatory function of the mediators, the cytokines and the proteases released during allergic reaction.     

Candidiasis and other fungal diseases of the mouth

The advent of the human immunodeficiency virus (HIV) and the increasing prevalence of immunocompromised individuals due to surgical and medical advances have resulted in a resurgence of opportunistic infections including oral candidiasis and other rare mycoses which were once considered exotic. It is now recognized that oral candidiasis may present in many clinical guises that may confound the unwary clinician. Other mycotic diseases such aspergillosis, cryptococcosis, histoplasmosis, and mucormycosis may manifest intraorally both as primary lesions and as secondary manifestation of systemic disease. The primary oral pathology of most of the latter mycoses is ulcerations that respond well to systemic therapy with the polyene, amphotericin B. In general, the management of oral fungal infections has been revolutionized by the triazole group of drugs, fluconazole and itraconazole, although recent reports indicate an alarming increase of resistant organisms in particular to fluconazole. The first part of this review attempts to provide an overview of clinical variants of oral candidiasis and current therapeutic techniques, while the latter part outlines the rare oral mycoses and their management.     

Pinpoint papular variant of polymorphous light eruption: clinical and pathological correlation

BACKGROUND: Polymorphous light eruption (PMLE) is the most common chronic idiopathic photodermatosis usually manifesting as a papular eruption along with several other morphological variants including a pinpoint papular variant. METHODS AND MATERIALS: Between June 1998 and August 2003, 10 PMLE patients presented to the Department of Dermatology at Henry Ford Hospital with complaints of a pruritic pinpoint papular eruption associated with sun exposure. In six patients skin biopsies were performed along with a detailed history and complete skin examination. We correlated the histology with the clinical course of disease corresponding to acute and subacute disease presentation. We also performed immunohistochemistry on three cases to study the immunophenotype in PMLE. RESULTS: The clinical, histologic and immunostain findings are summarized. Acute: Clinically pinpoint papules and vesicles, some with erythematous base, were seen. Histology showed focal vesicle formation, spongiosis, oedema, red blood cells extravasation, and superficial and deep perivascular and interstitial lymphocytic infiltrate with occasional eosinophils. Subacute: Clinically pinpoint papules with or without erythema were seen. Histology of the pinpoint lesion showed a nodular collection of lymphocytes and histiocytes with claw-like extension of epidermal rete ridges at the lateral boundaries of the lesion. Overlying epidermal atrophy with adjacent spongiosis, exocytosis, oedema and a superficial perivascular lymphocytic infiltrate and parakeratosis was also observed. The histologic differential diagnosis included lichen nitidus. Immunohistochemical stains revealed the following results: CD8, CD68 positive, CD4 variable (strongly positive to negative) and S-100 negative. CONCLUSION: (i) Pinpoint papular variant of PMLE is a distinct entity, which shows characteristic histology corresponding to the clinical course of the disease (acute and subacute). (ii) The histologic and immunophenotypic differential diagnosis of this variant during the subacute phase includes lichen nitidus.     

特比萘芬治疗念珠菌性外阴阴道炎疗效和安全性评价

目的观察特比萘芬治疗念珠菌性外阴阴道炎的疗效及安全性。方法选择本院念珠菌性外阴阴道炎患者,随机分为治疗组34例,口服特比萘芬250mg,1次/d;对照组31例,口服伊曲康唑200mg,1次/d。两组均连用10天。结果治疗组和对照组有效率分别为67.65%和87.10%,真菌清除率分别为82.35%和83.87%,两组有效率和真菌清除率比较差异均无显著性意义(P均>0.05)。结论口服特比萘芬治疗念珠菌性外阴阴道炎疗效肯定,安全性高。     

绵阳市男男性行为人群队列基线HIV/梅毒感染及影响因素分析

目的了解绵阳市男男性行为者(MSM)艾滋病感染现状和影响因素。方法采用应答推动抽样法(RDS),招募符合条件的MSM进行相关行为的寻问式匿名调查和检测前咨询、采集血液进行HIV/梅毒等血清学检测,建立随访队列。结果共调查采血400例,艾滋病病毒(HIV)感染率7.8%,梅毒累计感染率23.8%、现症感染率12.7%,HIV合并梅毒现症感染、梅毒累计感染的比例分别为16.7%和40.0%。单因素分析,不同经济收入、寻找性伴场所、近6个月性伴数、近6个月性伴主要来自偶然性伴、首次性交年龄、近6个月性伴最大年龄,是否近1年接受过同伴教育、梅毒感染(累计感染)者HIV感染率,不同年龄、职业、婚姻状况、性取向、经济收入、寻找性伴场所、首次性交年龄、距首次性交时间、近6个月性伴最大年龄,是否近6个月性伴主要是妻子、在家认识性伴者等梅毒感染率(累计感染率)有关。多因素分析,感染HIV的独立影响因素包括浴室/公园/网络为主要性伴场所场所、近6月性伴数≥6、首次性交年龄≥19岁、近6月性伴主要来自偶然性伴。梅毒感染(累计感染)的独立影响因素包括离异/丧偶/同居、性伴最大年龄≥26岁、近6月主要在家里认识性伴、浴室/公园寻找性伴。结论绵阳市MSM人群HIV/梅毒感染率较高,受多性伴、性伴来源、性伴年龄特征等因素影响,应针对性加大干预力度。     

2012-2015年汕头皮肤性病就诊者HIV检测结果分析

目的：了解近年来我院就诊者HIV感染情况。方法：对2012年1月至2015年12月在我院接受HIV检测的皮肤性病门诊及皮肤科住院部患者13571例行艾滋病血清学检测,并对检测结果及临床资料进行统计分析。结果：13571例接受HIV检测患者中HIV初筛试验阳性106例,对106例初筛试验阳性患者中的83例送检进行蛋白印迹确认试验,结果HIV抗体均阳性, 2012-2015年各年度HIV感染率分别为0.1928%(5/2593)、0.2726%(8 /2935)、 0.9890%(35/3539)、 0.7771%(35/4504),83例确认HIV抗体阳性患者中男性74例,女性9例,检出的男性HIV感染人数为女性感染人数的8.22倍,男性患者HIV感染率为女性患者的3.58倍,男女患者HIV感染率有显著的统计学差异（χ2 =14.99 ,P＜0.01）。结论：近两年汕头皮肤性病就诊人群HIV感染有明显的增长趋势,其中男性就诊者HIV感染增长尤为明显。     

913名吸毒人员HIV感染的相关行为调查

目的:分析广东省中山市吸毒人群HIV感染的相关行为、态度、知识,为制定预防措施提供依据。方法:采用访谈、问卷调查和血清流行病学对吸毒者进行横断面调查。结果:HIV感染率为5.37％。静脉注射吸毒占吸毒人员的49.9％;静脉注射吸毒共用针具率为64.19％;96.60％的人对艾滋病知识有一定的了解,但不全面。结论:针对该人群特点,采取有效的健康教育和干预措施,预防HIV在该人群中流行。     

赤峰市医院2004-2010年梅毒及HIV感染检出情况分析

目的探讨综合医院梅毒和HIV感染的流行病学特征。方法对本院2004年1月-2010年12月性病门诊患者和潜在血源传播患者进行检测时发现的梅毒患者和HIV感染者临床资料进行统计分析。结果共检测出梅毒患者528例,HIV阳性者11例,混合感染4例。11例HIV阳性患者中HIV感染者7例,AIDS4例。RPR滴度的差异在显性梅毒与隐形梅毒中具有统计学意义(P<0.05);梅毒患者的检出率在性病门诊组显著高于潜在血源传播患者组(P<0.05),并且两者在年龄分布与临床分期构成上差异均有统计学意义(P均<0.05);192例住院患者分布于骨科、肝胆外科、妇产科等26个科室。结论随着被检测人数的逐渐增多,该院检测出的梅毒患者和HIV感染者不断增多。性病门诊患者与潜在血源传播患者具有不同的梅毒流行病学特征。