Back issues No.3 - 2011 / Resident Forum  

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Diffuse papulosquamous eruptions in an HIV patient presenting with negative rapid plasma reagin test
Ming-Cheng Chien , Su-Ying Wen
DERMATOLOGICA SINICA 29 (2011) 113-114

A 35-year-old homosexual man presented to our dermatology clinic with a three-week history of skin rashes, on a background of current human immunodeficiency virus (HIV) infection and a negative testing result for syphilis infection. He was regularly followed-up in the infection out-patient department for the past two years. On physical examination, numerous pinkish to reddish oval maculopapules, with diameters ranging from 2 to 10mm, and overlying fine scales and crusts were seen on the neck, chest wall, back and proximal limbs (Figure 1). Involvements of palm or sole were not noted. The patient also complained of intermittent mild itching of the lesions. Serial laboratory tests were arranged and were found to have a negative testing of rapid plasma reagin (RPR). The lymphocyte count was 1580 cells/mL, CD4+ cell count was 483 cells/mL, HIV viral load was 17088 copies/mL. Skin sections exhibited dense lymphohistiocytic infiltration in the dermo-epidermal junction, and the upper dermis demonstrated perivascular infiltration. Vacuolar degeneration in the basal layer was observed and the dermis displayed some lymphocytic exocytosis and scattered plasma cells. (Figure 2) Most lymphoid cells were positive for CD3, with some found to be CD20(+) lymphocytes. The CD30 stain was negative. Ten days post-examination, the patient manifested generalized erythematous to dark-brown scaly maculopapules on the scalp, face, trunk and limbs. In addition, some oval reddish to brownish macules scattered over both palms and soles were also present (Figure 3).

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