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Cutaneous Pneumocystis carinii Infection in Patients With Acquired Immunodeficiency Syndrome

Cutaneous Pneumocystis carinii Infection in Patients With Acquired Immunodeficiency Syndrome Abstract • Extrapulmonary infection with Pneumocystis carinii is an uncommon event in which the skin may be affected rarely. All cases heretofore described in immunocompromised hosts have involved the external auditory canal and mastoid areas. We describe two patients with acquired immunodeficiency syndrome and extrapulmonary cutaneous P carinii infection that involved the glabrous skin. The first was a 31-year-old white man seropositive for human immunodeficiency virus with prior episodes of P carinii pneumonia and infection with Mycobacterium avium-intracellulare evaluated for translucent papules on the skin with an appearance similar to molluscum contagiosum infection. Biopsy confirmed the diagnosis of cutaneous pneumocystosis. The second patient was a 36-year-old homosexual man with long-standing liver disease with a persistent cough, fever, and an abnormal chest roentgenogram. Cutaneous evaluation revealed a bluish macule on the sternal notch that on skin biopsy was diagnostic of cutaneous pneumocystosis. Treatment with intravenous pentamidine resulted in resolution of the pulmonary and cutaneous problems in both cases. Extrapulmonary P carinii infection may involve the skin at sites other than the external auditory canal and may have a nondescript appearance. Histologic findings are similar to those of pneumocystosis found elsewhere. Clinicians should be familiar with the nondescript nature of the eruption as skin biopsy may be helpful in establishing a diagnosis of systemic pneumocystosis. (Arch Dermatol. 1991;127:1699-1701) References 1. Grimes MM, LaPook JD, Bar MH, Wasserman HS, Dwork A. Disseminated Pneumocystis carinii infection in a patient with acquired immunodeficiency syndrome . Hum Pathol. 1987;18:307-308.Crossref 2. Kwok S, O'Donnell JJ, Wood IS. Retinal cotton wool spots in a patient with Pneumocystis carinii infection . N Engl J Med. 1982;307:184-185. 3. Unger PD, Rosenblum M, Krown SE. Disseminated Pneumocystis carinii infection in a patient with acquired immunodeficiency syndrome . Hum Pathol. 1988;19:113-116.Crossref 4. Coulman CU, Greene I, Archibald RWR. Cutaneous pneumocystosis . Ann Intern Med. 1987;106:396-398.Crossref 5. Schinella RA, Breda SD, Hammerschlag PE. Otic infection due to Pneumocystis carinii in an apparently healthy man with antibody to the human immunodeficiency virus . Ann Intern Med. 1987; 106:399-400.Crossref 6. Murray JF, Felton CP, Garay SM, et al. Pulmonary complications of the acquired immunodeficiency syndrome . N Engl J Med. 1984;310:1682-1688.Crossref 7. Raviglione MC. Extrapulmonary pneumocystosis: the first 50 cases . Rev Infect Dis. 1990;12:1127-1138.Crossref 8. Gherman CR, Ward RR, Bassis ML. Pneumocystis carinii, otitis media and mastoiditis as the initial manifestation of the acquired immunodeficiency syndrome . Am J Med. 1989;85:250-252.Crossref 9. McCabe RE, Edelstein H. Atypical Pneumocystis carinii pneumonia (PCP) in patients receiving inhaled pentamidine prophylaxis (IPP) . Presented at the Fourth International Conference on AIDS; June 21,1990; San Francisco, Calif. 10. Noskin G, Murphy RL, Finn WG, Timins M. Extrapulmonary Pneumocystis carinii in patients receiving aerosolized pentamidine . Presented at the Fourth International Conference on AIDS; June 21, 1990; San Francisco, Calif. 11. Godfrey-Fausett P, Miller RF, Semple SJG. Nebulized pentamidine . Lancet . 1988;2:645-646.Crossref 12. Montgomery AB, Debs RJ, Luce JM, et al. Aerosolized pentamidine as sole therapy for Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome . Lancet . 1987;2:480-483.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Cutaneous Pneumocystis carinii Infection in Patients With Acquired Immunodeficiency Syndrome

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1991.01680100099012
Publisher site
See Article on Publisher Site

Abstract

Abstract • Extrapulmonary infection with Pneumocystis carinii is an uncommon event in which the skin may be affected rarely. All cases heretofore described in immunocompromised hosts have involved the external auditory canal and mastoid areas. We describe two patients with acquired immunodeficiency syndrome and extrapulmonary cutaneous P carinii infection that involved the glabrous skin. The first was a 31-year-old white man seropositive for human immunodeficiency virus with prior episodes of P carinii pneumonia and infection with Mycobacterium avium-intracellulare evaluated for translucent papules on the skin with an appearance similar to molluscum contagiosum infection. Biopsy confirmed the diagnosis of cutaneous pneumocystosis. The second patient was a 36-year-old homosexual man with long-standing liver disease with a persistent cough, fever, and an abnormal chest roentgenogram. Cutaneous evaluation revealed a bluish macule on the sternal notch that on skin biopsy was diagnostic of cutaneous pneumocystosis. Treatment with intravenous pentamidine resulted in resolution of the pulmonary and cutaneous problems in both cases. Extrapulmonary P carinii infection may involve the skin at sites other than the external auditory canal and may have a nondescript appearance. Histologic findings are similar to those of pneumocystosis found elsewhere. Clinicians should be familiar with the nondescript nature of the eruption as skin biopsy may be helpful in establishing a diagnosis of systemic pneumocystosis. (Arch Dermatol. 1991;127:1699-1701) References 1. Grimes MM, LaPook JD, Bar MH, Wasserman HS, Dwork A. Disseminated Pneumocystis carinii infection in a patient with acquired immunodeficiency syndrome . Hum Pathol. 1987;18:307-308.Crossref 2. Kwok S, O'Donnell JJ, Wood IS. Retinal cotton wool spots in a patient with Pneumocystis carinii infection . N Engl J Med. 1982;307:184-185. 3. Unger PD, Rosenblum M, Krown SE. Disseminated Pneumocystis carinii infection in a patient with acquired immunodeficiency syndrome . Hum Pathol. 1988;19:113-116.Crossref 4. Coulman CU, Greene I, Archibald RWR. Cutaneous pneumocystosis . Ann Intern Med. 1987;106:396-398.Crossref 5. Schinella RA, Breda SD, Hammerschlag PE. Otic infection due to Pneumocystis carinii in an apparently healthy man with antibody to the human immunodeficiency virus . Ann Intern Med. 1987; 106:399-400.Crossref 6. Murray JF, Felton CP, Garay SM, et al. Pulmonary complications of the acquired immunodeficiency syndrome . N Engl J Med. 1984;310:1682-1688.Crossref 7. Raviglione MC. Extrapulmonary pneumocystosis: the first 50 cases . Rev Infect Dis. 1990;12:1127-1138.Crossref 8. Gherman CR, Ward RR, Bassis ML. Pneumocystis carinii, otitis media and mastoiditis as the initial manifestation of the acquired immunodeficiency syndrome . Am J Med. 1989;85:250-252.Crossref 9. McCabe RE, Edelstein H. Atypical Pneumocystis carinii pneumonia (PCP) in patients receiving inhaled pentamidine prophylaxis (IPP) . Presented at the Fourth International Conference on AIDS; June 21,1990; San Francisco, Calif. 10. Noskin G, Murphy RL, Finn WG, Timins M. Extrapulmonary Pneumocystis carinii in patients receiving aerosolized pentamidine . Presented at the Fourth International Conference on AIDS; June 21, 1990; San Francisco, Calif. 11. Godfrey-Fausett P, Miller RF, Semple SJG. Nebulized pentamidine . Lancet . 1988;2:645-646.Crossref 12. Montgomery AB, Debs RJ, Luce JM, et al. Aerosolized pentamidine as sole therapy for Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome . Lancet . 1987;2:480-483.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Nov 1, 1991

References