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Lichenoid Eruption in a Patient With AIDS—Quiz Case

Lichenoid Eruption in a Patient With AIDS—Quiz Case Report of a case A 34-year-old woman presented with a 7-day history of a mildly pruritic eruption on her back and extremities. On further investigation, we learned that approximately 8 months before presentation, she had been diagnosed as having human immunodeficiency virus. Her medical history was otherwise unremarkable. Serologic testing revealed that she had been infected with hepatitis B, syphilis, and toxoplasmosis. One month later, a blood culture was positive for Mycobacterium avium–intracellulare complex (MAC). Single-agent therapy with ethambutol hydrochloride was initiated because the patient was unable to tolerate azithromycin. Two months after her diagnosis, she began antiretroviral therapy, which was discontinued shortly thereafter because of noncompliance and intolerance. She also was diagnosed as having pneumonitis due to cytomegalovirus infection. A bone marrow biopsy specimen obtained 1 month later revealed granulomatous inflammation, but no infectious organism was identified. Two months before presentation, antiretroviral therapy was restarted because the patient's CD4+ helper T-cell count was between 5 and 10/μL (0.005-0.01 × 109/L) (reference range, 443-1535/μL [0.44-1.54 × 109/L). After 1 month of antiretroviral therapy, her CD4+ cell count had increased to 125/μL (0.13 × 109/L), but the pruritic rash described above had started to develop. There was concern that a drug reaction might have occurred, so the antiretroviral therapy was discontinued. Physical examination revealed multiple erythematous lichenoid papules and plaques, which were concentrated on the upper extremities (Figure 1), back, and proximal aspect of the lower extremities. A biopsy specimen was obtained from a characteristic papule on the left forearm (Figure 2 and Figure 3). Figure 1. View LargeDownload Figure 2. View LargeDownload Figure 3. View LargeDownload What is your diagnosis? http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Lichenoid Eruption in a Patient With AIDS—Quiz Case

Lichenoid Eruption in a Patient With AIDS—Quiz Case

Abstract

Report of a case A 34-year-old woman presented with a 7-day history of a mildly pruritic eruption on her back and extremities. On further investigation, we learned that approximately 8 months before presentation, she had been diagnosed as having human immunodeficiency virus. Her medical history was otherwise unremarkable. Serologic testing revealed that she had been infected with hepatitis B, syphilis, and toxoplasmosis. One month later, a blood culture was positive for Mycobacterium...
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Publisher
American Medical Association
Copyright
Copyright © 2006 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.142.3.385-b
Publisher site
See Article on Publisher Site

Abstract

Report of a case A 34-year-old woman presented with a 7-day history of a mildly pruritic eruption on her back and extremities. On further investigation, we learned that approximately 8 months before presentation, she had been diagnosed as having human immunodeficiency virus. Her medical history was otherwise unremarkable. Serologic testing revealed that she had been infected with hepatitis B, syphilis, and toxoplasmosis. One month later, a blood culture was positive for Mycobacterium avium–intracellulare complex (MAC). Single-agent therapy with ethambutol hydrochloride was initiated because the patient was unable to tolerate azithromycin. Two months after her diagnosis, she began antiretroviral therapy, which was discontinued shortly thereafter because of noncompliance and intolerance. She also was diagnosed as having pneumonitis due to cytomegalovirus infection. A bone marrow biopsy specimen obtained 1 month later revealed granulomatous inflammation, but no infectious organism was identified. Two months before presentation, antiretroviral therapy was restarted because the patient's CD4+ helper T-cell count was between 5 and 10/μL (0.005-0.01 × 109/L) (reference range, 443-1535/μL [0.44-1.54 × 109/L). After 1 month of antiretroviral therapy, her CD4+ cell count had increased to 125/μL (0.13 × 109/L), but the pruritic rash described above had started to develop. There was concern that a drug reaction might have occurred, so the antiretroviral therapy was discontinued. Physical examination revealed multiple erythematous lichenoid papules and plaques, which were concentrated on the upper extremities (Figure 1), back, and proximal aspect of the lower extremities. A biopsy specimen was obtained from a characteristic papule on the left forearm (Figure 2 and Figure 3). Figure 1. View LargeDownload Figure 2. View LargeDownload Figure 3. View LargeDownload What is your diagnosis?

Journal

Archives of DermatologyAmerican Medical Association

Published: Mar 1, 2006

Keywords: acquired immunodeficiency syndrome,lichenoid eruptions

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