Cutaneous tuberculosis in three HIV-infected patients.

Although tuberculosis is a common disease in patients infected with HIV, cutaneous presentation is not commonly found. The authors report three HIV-infected patients with cutaneous tuberculosis and lung involvement. Patient 1 presented with a nodular skin lesion on the right forearm and the diagnosis was confirmed by histopathology and PCR study. Patients 2 and 3 presented with generalized erythematous papules and vesicopustules on the trunk and extremities. Culture grew M. tuberculosis in patient 2 and M. tuberculosis DNA was detected in the skin lesion of patient 3 by the PCR method.

Congenital erythropoietic porphyria: a case report.

Congenital erythropoietic porphyria is a rare autosomal recessive disorder of heme synthesis resulting from deficiency of uroporphyrinogen III synthase (UROIIIS). It is the most severe porphyria. The clinical manifestations are markedly variable due to the different mutation in the UROIIIS gene. We recently diagnosed a case of congenital erythropoietic porphyria. A 9-year-old boy presented with recurrent ulcers on the skin especially dorsum of the hands and feet since aged 3. The physical examination revealed ulcers on the dorsum of the feet, mutilation of the fingers, fluorescent erythrodontia, and darkening and hypertrichosis of the sun exposed area. Laboratory findings showed mild hemolysis, red urine, increased serum alkaline phosphatase level, and fluorescence of the red blood cell and urine. The histopathology was consistent with porphyria. The urine and plasma porphyrin levels confirmed the diagnosis of congenital erythropoietic porphyria. The administration of oral ultracarbon and topical zinc oxide has been tried.

Uncommon manifestations of opportunistic infections in an HIV infected patient.

A case of an HIV infected patient complicated with Penicillium marneffei and Rhodococcus equi infection is reported. He presented with chronic ulcer as pyoderma gangrenosum-like on his right calf and submandibular lymphadenitis as scrofuloderma-like. Penicillium marneffei and Rhodococcus equi were isolated from the ulcer and lymph node respectively.

Bacillary angiomatosis and mycobacterium infection coexisting in a cutaneous lesion in a patient with AIDS.

Bacillary angiomatosis is a recently recognized bacterial infectious disease. It mainly affects patients with acquired immunodeficiency syndrome. The presence of coexistent infections of more than one pathologic process in skin lesions in patients with AIDS has been demonstrated. We report a patient with AIDS in whom both bacillary angiomatosis and mycobacterium infection were documented within the same cutaneous lesion.

Disseminated cryptococcosis presenting as molluscum-like lesions in three male patients with acquired immunodeficiency syndrome.

Cryptococcosis is an opportunistic infection caused by a ubiquitous encapsulated yeast, Cryptococcus neoformans. The pulmonary infection is primary site and most frequently self-limited and may be asymptomatic. The most common recognized site of disseminated cryptococcosis is the central nervous system. The cutaneous cryptococcosis is rare and nonspecific. More recently, in patients with AIDS, some cases of cutaneous cryptococcosis resembling molluscum contagiosum have been described and occasionally appeared before systemic signs and symptoms. To our knowledge, this has not previously been reported in Thailand. This is a report of 3 males with acquired immunodeficiency syndrome who developed disseminated cryptococcosis with cutaneous lesions resembling molluscum contagiosum. Skin findings in disseminated cryptococcosis indicate a poor prognosis, however, earlier recognition and treatment would improve survival.

Disseminated cutaneous cytomegalic inclusion disease resembling prurigo nodularis in a HIV-infected patient: a case report and literature review.

Cytomegalovirus infection is common disease but most of the healthy patients are asymptomatic. Cytomegalovirus infection is a serious problem in immunocompromised patients particularly in acquired immunodeficiency syndrome. About 90 per cent of patients with AIDS develop active cytomegalovirus infection and up to 25 per cent may experience life threatening infection due to the virus. However, cytomegalovirus cutaneous lesion have rarely been reported. A 40-year-old Thai man presented with multiple prurigo nodularis-like lesions on both legs and feet. The investigation revealed consistent with acquired immunodeficiency syndrome associated with cytomegalovirus cutaneous infection.

An efficacy study of itraconazole in the treatment of Penicillium marneffei infection.

OBJECTIVES: to evaluate the efficacy and safety of itraconazole in treating P. marneffei infection. METHODS: Ten patients with previously untreated P. marneffei infection were given oral itraconazole at a dose of 200 mg twice a day for 2 months, followed by a dose of 100 mg once a day for 1 month. Efficacy was determined by the clinical and microbiological cure. RESULTS: All but one patient were seropositive for human immunodeficiency virus (HIV). Two patients died during therapy. Clinical improvement was evident in 8 patients. In 7 of these, the mean duration for becoming culture negative was 57 days. Five patients presented with relapse of P. marneffei infection within four months after completion of treatment. CONCLUSIONS: Itraconazole was shown to be effective in the initial treatment of P. marneffei infection. Relapse after treatment is common and long-term suppressive therapy is recommended.

Studies of human leprosy lesions in situ using suction-induced blisters: cell changes with IgM antibody to PGL-1 and interleukin-2 receptor in clinical subgroups of erythema nodosum leprosum.

To examine the immunopathogenesis of type 2 erythema nodosum leprosum (ENL) reactions in leprosy, we studied cellular and soluble immunologic components of skin lesions in 57 patients with reactions (19 acute ENL and 38 chronic ENL), 61 active patients without reactions, and 33 control patients whose leprosy had been treated and cured. Cells, IgM antibody to PGL-1 and Tac peptide levels were obtained from fluid aspirated from blisters induced by suction directly over representative skin lesions. During ENL reactions: a) the lesions in chronic ENL showed a decreased number of CD8+ (T-suppressor) cells and increased helper/suppressor ratio as compared to those in acute ENL and non-reactional leprosy; b) Tac peptide and IgM antibody to PGL-1 levels were elevated in the chronic ENL lesions; c) and systemic administration of corticosteroids appeared to cause a reduction in the intralesional CD4+ cell population and IgM antibody to PGL-1 but did not change CD8+ cell population and the levels of Tac peptide in the lesions. The elevated levels of Tac peptide were localized in the skin lesions while increased levels of IgM anti-PGL-1 seemed to be filtered from the peripheral blood. We conclude that spontaneous lymphocyte activation in situ, primarily of decreased CD8+ and relatively increased CD4+ cells, are important features of chronic, recurrent ENL reactions and may be an intermittent or cyclic phenomenon during the reaction. Understanding the mechanisms of these spontaneous changes in immunity in leprosy will enlarge our knowledge of reactions and of the underlying determinants of delayed type hypersensitivity and cell-mediated immunity in leprosy, which in turn will allow us to realize the potential for artificially manipulating these responses as proposed with vaccines or immunotherapy.