title: Post-ART epidermodysplasia verruciformis in a patient with AIDS.
abstract: Epidermodysplasia verruciformis (EV) is a rare disorder characterized by persistent human papillomavirus (HPV) infection. Here, we describe a 48-year-old, black, married male with AIDS, presenting a 1-year history of asymptomatic hypopigmented lesions that appeared 3 years after antiretroviral therapy (ART) initiation. Pre-ART, the initial CD4 count was 32 cells/mm(3) and the skin lesions appeared when the CD4 count reached 122 cells/mm(3). Dermatological examination demonstrated thin, scaly, slightly verrucous hypopigmented macules and papules, isolated or presenting with a linear aspect (Köbner phenomenon) in some areas, distributed on the neck, trunk, and superior and inferior members. Skin biopsy of a macular lesion revealed epidermal acanthosis with vacuolated keratinocytes presenting blue-gray pallor, arranged in clusters at the granular and upper spinous layer. Immunohistochemistry revealed expression of p16( INK4a) with diffuse positivity in the upper third of the epithelium, corresponding to the vacuolated keratinocytes. Polymerase chain reaction (PCR) was positive for type 12 HPV, and a diagnosis of EV-like associated to AIDS was made. EV-like is a rare disease and in this patent might be a manifestation of immune reconstitution inflammatory syndrome.
authors.affiliation: Enfermeira do Serviço de Assistência Especializada em DST/AIDS, Gerência de Dermatologia e DST/AIDS, Fundação de Medicina Tropical do Amazonas (FMTAM), Amazonas, Brazil.
authors.forename: Leila Cristina Ferreira
authors.initials: LC
authors.lastname: da Silva
authors.forename: Angelica Espinosa
authors.initials: AE
authors.lastname: Miranda
authors.forename: Luiz Carlos de Lima
authors.initials: LC
authors.lastname: Ferreira
authors.forename: Roberto Moreira
authors.initials: RM
authors.lastname: da Silva
authors.forename: Marcelo Távora
authors.initials: MT
authors.lastname: Mira
authors.forename: Carolina
authors.initials: C
authors.lastname: Talhari
authors.forename: Sinésio
authors.initials: S
authors.lastname: Talhari
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000276:immunology / Q000473:pathology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D044383:Black People; D001938:Brazil; D018791:CD4 Lymphocyte Count; D004819:Epidermodysplasia Verruciformis / Q000150:complications / Q000473:pathology* / Q000821:virology; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000276:immunology / Q000473:pathology*; D016133:Polymerase Chain Reaction; D012867:Skin / Q000473:pathology*
chemical_list: D044966:Anti-Retroviral Agents