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Skin-nontumor / Clinical Dermatology

Infectious disorders

HIV associated


Reviewer: Mowafak Hamodat MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns (Canada) (see Reviewers page)
Revised: 16 December 2014, last major update December 2010
Copyright: (c) 2002-2014, PathologyOutlines.com, Inc.

Definition
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● Acute human immunodeficiency virus infection (HIV) is a transient illness, typically presenting with an acute mononucleosis-like syndrome with mucocutaneous and constitutional symptoms, followed by detection of anti-HIV antibodies in peripheral blood

Clinical features
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Associated with various conditions:

Dermatitis: interface dermatitis occurs early in HIV infection, with pronounced vacuolization of basal keratinocytes; inflammatory infiltrate consists of CD8+ T cells expressing granzyme B7 and TIA1; also histiocytes but decreased Langerhans cells (Mod Pathol 2000;13:1232)
Drug reaction: see topic
Folliculitis: infants and adults; perifollicular chronic inflammatory infiltrate, often with follicular rupture, often with marked eosinophils and occasionally eosinophilic pustules in the outer root sheath or pilar canal of the hair follicle accompanied by perivascular and interstitial lymphohistiocytic infiltrate and eosinophil infiltrate in the superficial and deep dermis
Infections: scabies, fungi, mycobacteria, syphilis, bacillary angiomatosis
Lipodystrophy syndrome: therapy related complication of localized loss of fat (eMedicine)
Maculopapular eruptions: in 25%, in trunk with possible extension to extremities; nonspecific perivascular lymphocytes and histiocytes in upper dermis, variable papulovesicular foci with necrotic keratinocytes
Mucocutaneous manifestations: may occur early in disease course in children (Indian J Dermatol Venereol Leprol 2010;76:458)
Neoplasia: Kaposi's sarcoma, lymphoma (usually B cell), mycosis fungoides, oral and anorectal squamous cell carcinoma
Papular neutrophilic xanthoma: foamy macrophages, extracellular nuclear dust, hyaline necrosis of collagen fibers
Papular pruritic eruptions: anywhere on body; may wax and wane; superficial and mid-dermal perivascular lymphocytes with eosinophils, acanthosis, parakeratosis, superimposed excoriation or lichen simplex chronicus
Psoriasis: may be clinically confusing (Lancet Infect Dis 2010;10:470), see also topic
Seborrheic dermatitis: common, usually severe, involves trunk and extremities; may correlate with AIDS dementia (N Engl J Med 1984;311:189)
Vasculitis: occasionally leukocytoclastic, may be due to HIV directly or CMV
Viruses: herpes simplex (20%; painful perianal or perioral ulcers with large intranuclear inclusions), severe varicella-zoster infection, CMV (ulcerative lesions at mucocutaneous junctions), molluscum contagiosum, hairy leukoplakia, anal warts, bowenoid papulosis
Xerosis: generalized dry scale skin syndrome, associated with diminished sebum and sweat production accompanied by abnormal epidermal lipid release; may be associated with fissures and eczema

Clinical images
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Drug reaction

Lipodystrophy

Maculopapular and oral rash

Papular pruritic eruptions

Micro images
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Morbilliform drug eruption post-HAART treatment shows mild lichenoid and spongiotic reactions and subtle lymphocytic vasculopathic reaction in the upper dermis

Various images

Additional references
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J Clin Pathol 2008;61:802

End of Skin-nontumor / Clinical Dermatology > Infectious disorders > HIV associated


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