Cutaneous HIV-associated Kaposi sarcoma: a potential setting for management by clinical observation.

Kaposi sarcoma (KS) is a malignancy of viral etiology whose course ranges from cutaneous limited lesions to fulminant disease with multi-organ involvement. Four clinical variants of the disease exist: classic, endemic, iatrogenic, and epidemic. Iatrogenic and epidemic variants of Kaposi sarcoma develop in the setting of immune suppression. Transplant recipients who develop iatrogenic KS typically demonstrate improvement of lesions following de-escalation of immunosuppressive therapy. Similarly, HIV-infected patients who begin highly active antiretroviral therapy (HAART) experience immune reconstitution, which can induce KS regression. We describe two patients with varying clinical outcomes of cutaneous-limited HIV-associated KS after immune reconstitution with HAART. We propose that immune reconstitution with HAART, followed by clinical and radiographic surveillance for disease progression, may be an appropriate initial management strategy for limited cutaneous HIV-associated KS. In patients with more extensive disease at presentation or failure of HAART alone, antineoplastic therapy should be instituted.

Cutaneous manifestations of disseminated gonococcemia.

BACKGROUND: Sexually transmitted infections, includingurogenital gonorrheal infection, are a growing healthconcern in the United States. Nearly 50% of cervicalinfections are asymptomatic. If left undiagnosedand untreated, there is a risk of disseminatedinfection. PURPOSE: To describe an 18-year-old womanpresenting with disseminated gonococcal infectionconfirmed by blood cultures, skin biopsy, and urinegonococcal probe. We also describe the presentation,diagnosis, and treatment of disseminated gonococcalinfection, including discussion of the variousmorphologies of cutaneous lesions that have beenreported in the literature. MATERIALS AND METHODS: Thefeatures of a woman with disseminated gonococcalinfection are presented. Using PubMed, the termscutaneous, disseminated, gonococcal, gonorrhea,infection, lesions, manifestations, pustules, skin, andsystemic were searched. Relevant citations wereutilized and discussed. RESULTS: Hemorrhagic pustules,petechiae, and purpuric lesions developed in a youngwoman with fever and joint pain. Blood cultures grewbeta lactamase negative Neisseria gonorrhoeae andthe Neisseria gonorrhoeae/Chlamydia trachomatisprobe was positive for both N. gonorrhoeae and C.trachomatis. Biopsy revealed bulla with neutrophils,extravasated erythrocytes, fibrin deposits in the vesselwalls, and leukocytoclasia. CONCLUSION: Cutaneouslesions of disseminated gonococcal infection caninclude abscesses, cellulitis, petechiae, purpuricmacules, necrotizing fasciitis, and vasculitis. It isimportant for the clinician to recognize the clinicalsigns and symptoms of disseminated gonococcalinfection, particularly the various cutaneousmanifestations.

Associated conditions in patients with multiple dermatofibromas: Case reports and literature review.

Dermatofibromas are benign, fibrohistiocytic, dermal tumors. Solitary dermatofibromas may be incidental findings, whereas multiple dermatofibromas may be associated with systemic conditions or previous therapies. Two women and one man with multiple dermatofibromas and an associated systemic condition, immunosuppression, or both, are described. Nine dermatofibromas developed in a woman with hypothyroidism, optic neuritis, and Arnold Chiari I malformation. Five dermatofibromas developed in a woman with breast cancer who had received several systemic antineoplastic therapies. Eleven dermatofibromas developed in a man with HIV whose systemic therapies included acyclovir, darunavir/cobicistat, dolutegravir, etravirine, and ritonavir. Conditions associated with multiple dermatofibromas include autoimmune diseases, cancer, chromosomal abnormalities, immunodeficiencies, metabolic disturbances, and altered physiologic states such as pregnancy. Medications received by patients with multiple dermatofibromas included immunosuppressive agents, psoriasis therapies, and antineoplastic drugs. Multiple dermatofibromas can be observed in patients with associated medical conditions, systemic therapies, or both. Therefore, in individuals presenting with multiple dermatofibromas, not only evaluation for associated disorders, but also review of prior and current drug therapies, should be considered.