Photolichenoid plaques with associated vitiliginous pigmentary changes.
A 49-year-old man with advanced HIV/AIDS on anti-retroviral therapy (HAART) and trimethoprim-sulfamethoxazole (TMP-SMX) presented with a several-month history of pruritic, erythematous, lichenified papules that coalesced into hyperkeratotic plaques on the trunk and extremities in a sun-exposed distribution. He shortly thereafter developed a progressive depigmentation over more than 80 percent of his body surface area. A biopsy specimen of an erythematous plaque on the trunk showed a superficial and mid-dermal infiltrate of lymphocytes with eosinophils, most consistent with either chronic lichenoid drug eruption or atypical lymphoproliferative disorder (ACLD) of HIV. The patient's lichenoid skin disease has persisted despite discontinuation of TMP-SMX, although it has improved partially with administration of topical glucocorticoids and acitretin. His depigmentation has continued to progress. We discuss the overlapping diagnostic entities which may be comprised by this patient's clinical disease, and highlight a unique presentation of the complex interaction between HIV infection and the skin.
Department of Dermatology, New York University, New York, New York, USA.
Kathleen
K
Tran
Rachael
R
Hartman
Julia
J
Tzu
Shane
S
Meehan
Scott E
SE
Sanders
Miriam Keltz
MK
Pomeranz
Miguel
M
Sanchez
D017255:Acitretin / Q000009:adverse effects / Q000627:therapeutic use; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D016470:Bacteremia / Q000150:complications; D003937:Diagnosis, Differential; D018450:Disease Progression; D004485:Eczema / Q000175:diagnosis; D004890:Erythema / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006561:Herpes Simplex / Q000150:complications; D006801:Humans; D017512:Lichenoid Eruptions / Q000175:diagnosis / Q000473:pathology*; D016410:Lymphoma, T-Cell, Cutaneous / Q000175:diagnosis; D008232:Lymphoproliferative Disorders / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010787:Photosensitivity Disorders / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D019310:Pseudolymphoma / Q000175:diagnosis; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000009:adverse effects / Q000627:therapeutic use; D014467:Ultraviolet Therapy; D014820:Vitiligo / Q000150:complications / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy
D019380:Anti-HIV Agents; D005938:Glucocorticoids; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D017255:Acitretin