Ten Years of HIV Diagnosis in a Dermatology and Venereology Department: A Retrospective Study on Demographic, Clinical, and Laboratory Characteristics. / [Artículo traducido] Diez años de diagnóstico de VIH en un Departamento de Dermatología y Venereología: un estudio retrospectivo sobre características demográficas, clínicas y de laboratorio.

Human immunodeficiency virus (HIV) transmission remains an important health issue, with a high burden that is felt across the world. This work aims to analyze the demographic, clinical, and laboratory characteristics of newly diagnosed patients with HIV in a Department of Dermatology and Venereology. A retrospective observational study was conducted from all health records of newly diagnosed patients with HIV from a Dermatology unit from January 2011 to December 2020. A total of 134 patients with new HIV diagnoses were included in the analysis. Concurrent dermatological or venereal diseases were diagnosed in 91.0% of the patients (n=122), being the most common conditions syphilis (22.4%, n=30) and urethritis (14.9%, n=20). Out of all the patients with diagnoses of concurrent sexually transmitted infection (STI) (41.0%, n=55), syphilis was reported in 81.8% of the patients (n=45), gonorrhea in 9.1% (n=5), and chlamydia in 5.5% (n=3). We present a large patient database on the clinical conditions associated with newly diagnosed HIV, concluding that infectious diseases were the most common conditions associated with newly diagnosed HIV.

Ten Years of HIV Diagnosis in a Dermatology and Venereology Department: A Retrospective Study on Demographic, Clinical, and Laboratory Characteristics.

Human immunodeficiency virus (HIV) transmission remains an important health issue, with a high burden that is felt across the world. This work aims to analyze the demographic, clinical, and laboratory characteristics of newly diagnosed patients with HIV in a Department of Dermatology and Venereology. A retrospective observational study was conducted from all health records of newly diagnosed patients with HIV from a Dermatology unit from January 2011 to December 2020. A total of 134 patients with new HIV diagnoses were included in the analysis. Concurrent dermatological or venereal diseases were diagnosed in 91.0% of the patients (n=122), being the most common conditions syphilis (22.4%, n=30) and urethritis (14.9%, n=20). Out of all the patients with diagnoses of concurrent sexually transmitted infection (STI) (41.0%, n=55), syphilis was reported in 81.8% of the patients (n=45), gonorrhea in 9.1% (n=5), and chlamydia in 5.5% (n=3). We present a large patient database on the clinical conditions associated with newly diagnosed HIV, concluding that infectious diseases were the most common conditions associated with newly diagnosed HIV.

The role of dermatology in African patients referred for health treatment in a European centre.

BACKGROUND: Owing to the migratory movement between African and European countries, we have been seeing an increasing number of dermatoses in patients with darker skin phenotypes in our clinical practice. AIM: To evaluate the support provided by outpatient dermatology consultations to such patients and to assess the most frequent dermatoses seen in this population. METHODS: A retrospective 5-year study was conducted in a Portuguese hospital, which is a referral centre to several medical specialities for patients evacuated from Portuguese-speaking African countries, under a specific agreement of international cooperation in health. RESULTS: In total, 116 patients, with a mean age of 38 years, were evaluated. In total, 47 dermatoses were identified, with the 6 most common being fungal infections (12.1%), eczema (9.5%), dyschromias (8.6%), xerosis (6.9%), acne (6%) and hair disorders (6%). CONCLUSIONS: This increased knowledge about the most frequent dermatoses in this population, along with their manifestations and the factors that influence them should allow better diagnosis and therapy.

Psoriasis in HIV infection: an update.

Psoriasis is a prevalent systemic immune-mediated disease with cutaneous manifestations. In HIV-infected patients, psoriasis may have a higher incidence, present atypical and more exuberant clinical features, and is frequently recalcitrant to treatment. Despite this aggravated severity, treatment options for psoriasis in HIV-infected individuals remain limited due to the risk of fatal immunosuppression associated with both classical immunosuppressants and new biological drugs. Notwithstanding, drug therapy in psoriasis has been undergoing major advances for the last few years, with novel drugs approved, which could significantly add to the management of HIV-infected patients. It is therefore our aim to present a review of the available literature to highlight the updated evidence on psoriasis in HIV-infected individuals, particularly in regards to its epidemiology, proposed pathophysiology, clinical presentation, currently available therapeutic options, and future perspectives.

Eruptive melanocytic nevi in HIV infected patients: report of three cases.

The abrupt development of multiple melanocytic nevi has been described in association with many conditions, including human immunodeficiency virus infection. We report three cases of eruptive nevi in men with human immunodeficiency virus type 1 infection. One patient developed this phenomenon during the stage of acquired immunodeficiency syndrome. The other two patients had human immunodeficiency virus infection recently diagnosed and presented to our clinic reporting the development of multiple melanocytic nevi after starting highly active antiretroviral treatment, with improvement of their immunity. To our knowledge, this is the first report of eruptive melanocytic nevi as a possible consequence of the immune reconstitution inflammatory syndrome.

Herpes simplex virus and cytomegalovirus co-infection presenting as exuberant genital ulcer in a woman infected with human immunodeficiency virus.

In patients infected with human immunodeficiency virus (HIV), genital herpes can result in severe and atypical clinical presentations, and can become resistant to aciclovir treatment. Rarely, these manifestations may represent concurrent herpes simplex virus (HSV) with other agents. We report a 41-year-old black woman with HIV who presented with extensive and painful ulceration of the genitalia. Histological examination of a biopsy sample was suggestive of herpetic infection, and intravenous aciclovir was started, but produced only partial improvement. PCR was performed on the biopsy sample, and both HSV and cytomegalovirus (CMV) DNA was detected. Oral valganciclovir was started with therapeutic success. CMV infection is common in patients infected with HIV, but its presence in mucocutaneous lesions is rarely reported. This case exemplifies the difficulties of diagnosis of genital ulcers in patients infected with HIV. The presence of exuberant and persistent HSV genital ulcers in patients with HIV should also raise suspicions of the presence of co-infection with other organisms such as CMV.

An atypical case of cutaneous leishmaniasis caused by Leishmania infantum in Portugal.

Leishmaniasis is a parasitic disease caused by an intracellular protozoan that belongs to the genus Leishmania and is transmitted by a phlebotomine sandfly. In Southwest Europe, including Portugal, cutaneous leishmaniasis is considered a rare disease of unknown or underestimated prevalence. Leishmania infantum is the only species identified as responsible for the autochthonous cases.We report the case of a 66-year-old man with an erythematous, painless plaque on the mid face region, accompanied by nasal obstruction with 9 months of evolution. The initial diagnoses were: lymphoma, subcutaneous mycosis, Wegener's granulomatosis, and lupus vulgaris. The diagnosis of leishmaniasis was based on histopathology findings and identification of L. infantum by DNA based methods. Blood cultures, abdominal ultrasound and myelogram ruled out systemic involvement. The patient was treated with intravenous meglumine antimoniate (20 mg per kg/day) for four weeks, without major side effects.We emphasize the importance of this case because human cutaneous leishmaniasis has rarely been diagnosed in Portugal and some cases are atypical, such as the situation herein described.

Unusual head metastasis of kidney cancer.

Renal cell carcinoma (RCC) metastasis can involve any organ. Head metastasis are rare, namely tongue, scalp and nose and only a few cases have been described. The authors describe three cases of unusual presentation of head metastasis of RCC. In case 1, a 50-year-old man with RCC underwent left nephrectomy, and presented 16 months later with nasal metastasis. In case 2, a 64-year-old woman with RCC operated 12 years ago, relapsed at multiple sites including scalp, which was treated surgically. In case 3, a 47-year-old man with RCC developed metastasis in multiple organs including a mass on the tongue that was operated and was compatible with primary tumour metastasis. These cases show the importance of correct diagnosis of rare presentations and local treatment of metastasis of RCC.

Sexually transmitted infections in pregnant adolescents: prevalence and association with maternal and foetal morbidity.

BACKGROUND: Pregnant adolescents have a high incidence of sexually transmitted infections and higher risk of adverse birth outcome. OBJECTIVES: To assess the prevalence of sexually transmitted infections in pregnant adolescents and the associations between these infections and adverse birth outcome. METHODS: A prospective study with a face-to-face interview to pregnant adolescents was followed by first-void urine and cervical swabs collection for polymerase chain reaction testing for Chlamydia trachomatis and Neisseria gonorrhoeae. After child delivery, clinical files were also reviewed for serological and microbiological results for other infections and data concerning maternal-foetal morbidity. A 5% level of significance was used. RESULTS: The inclusion criteria were fulfilled by 204 pregnant adolescents, and the prevalence of C. trachomatis was 11.8% and of N. gonorrhoeae was 4.9%, with the majority being asymptomatic. No antibodies for syphilis or human immunodeficiency virus were found. Maternal morbidity occurred in 3.4%, prematurity was observed in 11.8% of the newborns and low birth weight in 9.8%. Statistically significant associations were observed between maternal morbidity and the presence of gonorrhoea, younger adolescents and severe prematurity and between infection with C. trachomatis and/or N. gonorrhoea and low birth weight. CONCLUSIONS: Sexually transmitted infections are frequently asymptomatic and cause maternal-foetal morbidity. The opportunity that pregnancy offers for screening and counselling should not therefore be missed, especially in adolescents.