Increased cutaneous toxicity to ionizing radiation in HIV-positive patients

Background There are reports of increased reactions in HIV-1 + patients to ultraviolet light sometimes in association with medication. In addition, there are also reports of increased morbidity associated with radiation therapy in HIV-1 + patients. Methods Three HIV-1 + patients developed cutaneous toxic reactions to radiation therapy; two with Kaposi's sarcoma (KS) and one with non-Hodgkin's lymphoma. Conclusions Although the mechanisms which resulted in these reactions are not clear, they may be related to depletion of endogenous scavengers and may be accentuated by the pattern of immune dysregulation present in HIV-1 disease.     

Clinical considerations in digitate dermatosis

A 53-year-old man presented for evaluation of erythematous plaques over the trunk which had been present for several months. The lesions were asymptomatic and were not changing in appearance or number. The patient was in otherwise good health and had no history of dermatologic problems.
Significant physical findings were well-defined, elongated, erythematous plaques lying in parallel along both sides of the lower trunk (Figs la and 1b). There was no lymphadenopathy or visceral enlargement. A skin biopsy showed a lymphocytic perivascular infiltrate with epidermal spongiosis, acanthosis, and parakeratosis. On the basis of the clinical and histopathologic findings, and diagnosis of digitate dermatosis was established and the patient has done well without treatment.     

Pityriasis lichenoides et varioliformis acuta in HIV-1 + patients: a marker of early stage disease

Background The high incidernce of cutaneous disease in HIV-1 + patients may be a marker of the chronic state of immune activation. In addition, specific cutaneous diseases may be related to the pattern and degree of immune dysregulation present in the patients at the time of the eruption. We have observed that HIV-1 + patients with pityriasis lichenoides et varioliformis acuta (PLEVA) were in the early to midstage of HIV-1 disease. Materials and methods To determine if there was a correlation between the phenotype of the lymphoid infiltrate and surface markers of the epidermis and the known changes in early or late-stage HIV-1 disease, we studied five HIV-1 + patients with PLEVA. Cutaneous biopsy specimens were obtained and immunohistochemical stains were used to determine the expression of ELAM-1, ICAM-1, and HLA-DR and the phenotype of the lymphoid infiltrate. Results The HIV-1 + patients showed increased expression of HLA-DR on keratinocytes as well as on the mononuclear and dendritic cell populations in the epidermis and dermis. The majority of T cells were activated CD8+ cells. Conclusions Immunophenotyping of the inflammatory infiltrate in these patients is consistent with a pattern of immune dysregulation seen only in earlier stages of HIV-1 disease. Thus, PLEVA may be useful as a marker of early to midstages of HIV-1 disease.     

Aortic insufficiency and pelvospondylitis in a seropositive female with rheumatoid nodules

Aortic insufficiency appeared in a female patient with seropositive, nodular rheumatoid arthritis. X-ray changes of pelvospondylitis strongly suggested ankylosing spondylitis. Aortic insufficiency and pelvospondylitis are discussed as they relate to rheumatoid arthritis and ankylosing spondylitis.