Evaluation of Immune-enhancing Effects of Ibuprofen in an Immunodeficiency Model

Three children and one adult with chronic mucocutaneous candidosis with documented deficient cellular immunity to Candida antigen were evaluated as a model to study the specific cellular immune-enhancing potential of the prostaglandin synthetase inhibitor ibuprofen. Oral ibuprofen failed to have any consistent effect during sequential 4-week on and off cycles on the following parameters: delayed hypersensitivity skin testing; lymphocyte transformation to Candida antigen; T-cell subsets as determined by monoclonal antibody techniques; production of human immune interferon in response to staphylococcal enterotoxin A (SEA). Two patients showed a trend toward enhanced lymphocyte transformation to PHA while taking ibuprofen. In two patients who were studied 8-10 weeks after discontinuation of oral ketoconazole therapy, clinical recurrence of CMC was not prevented by oral ibuprofen therapy.     

Psoriasis Associated with Human Immunodeficiency Virus in an Infant

Psoriasis is commonly reported in association with HIV in adults. A 3-month-old girl with HIV presented with a widespread eruption and was diagnosed with psoriasis. This is the first infant reported with psoriasis in association with HIV infection. The relationship between the two entities is discussed, as is the role of treatment with zidovudine.     

Ibuprofen in the treatment of UV-B-induced inflammation

Ibuprofen and placebo were compared in a randomized, double-blind, cross-over study of 19 psoriatic patients receiving UV-B phototherapy to evaluate the symptomatic relief of UV-B-induced inflammation. Signs and symptoms of UV-B-induced inflammation (erythema, pruritus, skin pain, general discomfort, and nocturnal restlessness) were assessed for each treatment. An evaluation of 104 treatments disclosed that, although ibuprofen significantly reduced technician-observed erythema, it was not significantly different from placebo for the five other end points studied. Separate evaluations of higher dose UV-B treatments showed a small, but statistically significant, reduction with ibuprofen for four of the six end points evaluated. The data suggest that ibuprofen is more effective than placebo for the relief of symptoms associated with UV-B-induced inflammation after high dose UV-B phototherapy for psoriasis, but the drug has limited usefulness in the treatment of sunburn reaction from these same doses.     

以免疫重建为主要表现的艾滋病相关型卡波西肉瘤1例

患者男,33岁,诊断为获得性免疫缺陷综合征(艾滋病期)。在启动高效抗逆转录病毒治疗(HAART)后,CD4计数持续回升,病毒载量检测不到。至5个月时,出现咳嗽、恶心、淋巴结肿大、单发皮肤结节等,淋巴结活检病理证实为卡波西肉瘤。2个疗程化疗之后临床症状缓解,随访至今无复发。卡波西肉瘤可以作为免疫重建的一种临床表现,化疗能达到临床缓解,成功的抗病毒治疗有助于长期病情稳定。     

Disseminated Histoplasmosis Presenting as an Ulcerated Verrucous Plaque in a Human Immunodeficiency Virus-Infected Man

A 46-year-old homosexual man with disseminated histoplasmosis and human immunodeficiency virus (HIV) infection had a histoplasmosis-related ulcerated verrucous plaque above his left upper lip; systemic and cutaneous disease manifestations of histoplasmosis resolved with daily ketoconazole therapy. Disseminated histoplasmosis, with similar cutaneous features, also was present in his HIV-seropositive male sexual partner. The possibility of human-to-human transmission of histoplasmosis between these patients is considered and the skin lesions of systemic fungal infections in HIV-infected patients are reviewed.     

Acute Graft-versus-Host Disease with Unusual Cutaneous Intracellular Vacuolation in an Infant with Severe Combined Immunodeficiency

Abstract: We report an infant with severe combined immunodeficiency (SCID) who had cutaneous manifestations of acute graft-versus-host disease (GVHD) due to maternofetal lymphocyte engraftment. Histologic and ultrastructural examinations of the skin revealed intracellular vacuoles resembling lipid droplets in the epidermis and dermis, which is not a recognized feature of acute GVHD or SCID.     

Cutaneous Manifestations of Acquired Immunodeficiency Syndrome in Children

Cutaneous disorders are among the most common manifestations of HIV infection in both children and adults. Because of the obvious visibility of the integument, these lesions are often the presenting manifestation of HIV-related disease. The cutaneous afflictions are frequently related to the sequelae of impaired immunity and include opportunistic infections and neoplasms as well as dramatic exacerbations and/or the development of rapidly progressive and severe manifestations in pre-existing, normally benign dermatoses. In many cases of AIDS, iatrogenic cutaneous disorders associated with toxic or allergic drug reactions are seen. With the increasing incidence of pediatric HIV infection and with therapeutic prolongation of survival, certain cutaneous manifestations (especially drug reactions) are likely to become more common. Kaposi sarcoma and other neoplasms may be recognized with increased frequency in HIV-infected children. New or previously unrecognized cutaneous manifestations of pediatric AIDS are likely to emerge. Familiarity with the various dermatologic presentations of pediatric AIDS can result in the earlier diagnosis and treatment of the disease and, hopefully, the prolongation of the patient's life.     

Disseminated Varicella Zoster Virus in an Immunized Child as the Acquired Immunodeficiency Syndrome‐defining Illness

Abstract: Varicella zoster virus (VZV) immunization aids in the prevention of future VZV infections in immunocompetent patients; however, severely immunocompromised patients remain at increased risk of VZV infection. We report a case of a 10‐year‐old boy previously immunized to Varicella who presented with herpes zoster with hematogenous dissemination as the Acquired Immunodeficiency Syndrome‐defining illness. Disseminated VZV is more commonly seen in human immunodeficiency virus (HIV)‐infected individuals with more advanced disease, as was the case with our patient. Disseminated VZV infection in a previously immunized child should raise suspicion for underlying immunosuppression.     

Hypohidrotic Ectodermal Dysplasia,Osteopetrosis, Lymphedema,and Immunodeficiency in an Infant with Multiple Opportunistic Infections

Osteopetrosis, lymphedema, hypohidrotic ectodermal dysplasia, and immunodeficiency (OL‐HED‐ID) is a rare X‐linked disorder with only three reported prior cases in the English‐language literature. We describe a case of OL‐HED‐ID in a male infant who initially presented with congenital lymphedema, leukocytosis, and thrombocytopenia of unknown etiology at 7 days of age. He subsequently developed gram‐negative sepsis and multiple opportunistic infections including high‐level cytomegalovirus viremia and Pneumocystis jiroveci pneumonia. The infant was noted to have mildly xerotic skin, fine sparse hair, and periorbital wrinkling, all features suggestive of ectodermal dysplasia. Skeletal imaging showed findings consistent with osteopetrosis, and immunologic investigation revealed hypogammaglobulinemia and mixed T‐ and B‐cell dysfunction. Genetic testing revealed a novel mutation in the nuclear factor kappa beta (NF‐KB) essential modulator (NEMO) gene, confirming the diagnosis of OL‐HED‐ID. Mutations in the NEMO gene have been reported in association with hypohidrotic ectodermal dysplasia with immunodeficiency (HED‐ID), OL‐HED‐ID, and incontinentia pigmenti. In this case, we report a novel mutation in the NEMO gene associated with OL‐HED‐ID. This article highlights the dermatologic manifestations of a rare disorder, OL‐HED‐ID, and underscores the importance of early recognition and prompt intervention to prevent life‐threatening infections.     

Ibuprofen and hydrogel-released ibuprofen in the reduction of inflammation-induced migration in melanoma cells

Background  There is growing evidence that inflammation may exacerbate cancer metastasis and several clinical studies show that taking nonsteroidal anti-inflammatory drugs appears to reduce metastases.
Objectives  The aims of this study were: (i) to examine the effects of ibuprofen on the major proinflammatory cytokine tumour necrosis factor (TNF)-α induction of migration of C8161 and HBL human melanoma cells; (ii) to develop ibuprofen-releasing hydrogels (Pluronics F127) for future topical use in reducing metastatic spread of primary melanoma; and (iii) to examine whether the actions of ibuprofen might be explained by induction of apoptosis.
Methods  Melanoma cells were exposed to 300 U mL⁻¹ TNF-α for a 24-h period prior to making a scratch wound to which ibuprofen or ibuprofen-loaded hydrogels were then added. The effects of relevant concentrations of ibuprofen on cell viability and apoptosis were examined.
Results  Ibuprofen at 10⁻³ mol L⁻¹ significantly reduced TNF-α-stimulated migration of both cell types to that of nonstimulated cells ( P  < 0·001). TNF-α-unstimulated cell migration was not significantly affected. Cells responded similarly to SS and SR forms of ibuprofen. Cells treated with ibuprofen sodium salt-loaded hydrogels showed a significant reduction in migration when compared with unloaded hydrogels. Ibuprofen induced apoptosis in HBL cells but had no effect on C8161 melanoma cells apoptosis at concentrations that reduced migration.
Conclusions  These results demonstrate that TNF-α upregulated malignant melanoma migration in vitro and that this could be reduced by ibuprofen both in solution and delivered from a hydrogel. These effects of ibuprofen cannot be attributed simply to induction of apoptosis.     

Epidermodysplasia verruciformis in a Setting of Common Variable Immunodeficiency

A 14-year-old native American female with common variable immunodeficiency was admitted for bone marrow transplantation. Preoperative evaluation showed a generalized lichenoid papular eruption present for several years. Light microscopy revealed expansion of the epidermis by atypical keratinocytes; electron microscopy showed intranuclear papillomavirus inclusions within the granular keratinocytes; DNA hybridization revealed a type 5-related human papilloma virus homology. Four days after bone marrow transplantation the lichenoid papules blackened and began to disappear. Within 30 days after bone marrow transplantation the distribution and appearance of the papules was similar to that of the pretransplantation evaluation. One year after transplantation the patient showed evidence of a successful T lymphocyte graft. No transformation to squamous cell carcinoma had occurred. Epidermodysplasia verruciformis has been associated with deficient cell-mediated immunity, the varying severity of which does not predict the tendency to neoplasm formation (2, 5). Several distinct human papillomavirus genomes have been recovered with DNA hybridization techniques in these patients. It is hoped that the bone marrow transplantation might be associated with diminished transformation to squamous cell carcinoma.     

Skin Disease in Korean Human Immunodeficiency Virus Patient

BackgroundIn Korea, new human immunodeficiency virus (HIV) patients continue to be diagnosed. Due to the development of highly active anti-retroviral therapy (HAART) and lengthening of survival period of infected person, the aspect of skin diseases of HIV-infected patients is also changing.ObjectiveTo determine skin diseases of HIV-infected patients according to immune status and the relationship between folliculitis and HAART drug.MethodsSubjects were HIV-infected patients who were treated in the department of dermatology from September 1, 2008 to August 31, 2018. Medical records of 376 subjects were retrospectively analyzed.ResultsOf 376 patients were studied, tinea infection, folliculitis, and seborrheic dermatitis were the most common regardless of their CD4 T cell counts or treatment group (initial treatment or retreatment). Seborrheic dermatitis, irritant contact dermatitis, and pruritic papular eruption were significantly more common in patients with CD4+T cells less than 200×10⁶ cells/L while warts were significantly more frequent in patients with CD4+T cells greater than 200×10⁶ cells/L. Most HAART agents were found to be helpful in reducing the incidence of folliculitis.ConclusionThere were many skin diseases in HIV patients, different from previous studies. In our study, the top three diagnoses were tinea infection, folliculitis, and seborrheic dermatitis. HAART medication was helpful in reducing folliculitis. These changes will require different treatments for skin diseases in HIV patients.     

拉氧头孢治疗无合并症性淋病50例疗效观察

目的：分析应用拉氧头孢治疗单纯性淋病的效果。方法：选择门诊单纯性淋病患者１００名,随意分为两组,每组５０名。治疗组应用拉氧头孢,对照组应用淋必治,迸行对照治疗。结果：拉氧头孢治疗组治愈率８８％,淋必治治疗组９０％,拉氧头孢疗效与淋必治相侧（ｘ２＝０．１０１,Ｐ＞０．０５）。结论：拉氧头孢治疗单纯性淋病疗效好,是一种治疗淋病有效、安全的可供临床选用的药物。     

Extensive Tinea in a Patient With Severe Combined Immunodeficiency

Abstract:   Severe combined immunodeficiency (SCID) is a heterogeneous group of disorders characterized by a defect of T and B cell immunity with a genetic origin in most cases. Although the X-linked recessive form is most common (60–70%), there are autosomal recessive forms (20%) and spontaneous mutations. While SCID may present with many nosocomial infections, dermatophyte infections are not common. We reported a case of SCID which was associated with a widespread skin infection with Trichophyton mentagrophytes .