ABSTRACT
Abstract A 56-year-old male, HIV-positive, presented with a 3-day history of multiple indurated erythematous nodules with superficial and well-defined erosions on his right gluteus. Skin biopsy showed ballooning-necrotic keratinocytes and cultures were positive for herpes simplex 2. Genital herpes simplex infection recurrences may not be restricted to the anterior part of the genitalia and clinical presentation in the lumbar area or gluteus must be differentiated from varicella-zoster virus infection. Tumor-like presentation is a very rare manifestation of HSV cutaneous infection. It is important to take this morphological variant into consideration not to delay the diagnosis of a viral infection, especially in an immunosuppressed patient.
Subject(s)
Humans , Male , Herpes Genitalis/diagnosis , HIV Infections/complications , Herpes Simplex/diagnosis , Herpes Zoster , Middle Aged , Neoplasm Recurrence, LocalSubject(s)
Adult , Drug-Related Side Effects and Adverse Reactions/epidemiology , Drug-Related Side Effects and Adverse Reactions/etiology , Female , Humans , Immunoconjugates/administration & dosage , Immunoconjugates/adverse effects , Male , Middle Aged , Psoriasis/chemically induced , Psoriasis/epidemiology , Psoriasis/etiologyABSTRACT
En la actualidad, para diagnosticar pénfigo, es necesaria una clínica con ampollas y erosiones, histopatología con acantólisis y detección de anticuerpos en la piel afectada (inmunofluorescencia directa) o en sangre circulante (inmunofluorescencia indirecta). Objetivos: Los objetivos del trabajo son comparar la sensibilidad y especificidad de estas dos últimas técnicas y demostrar si existe relación de los niveles de ELISA frente a desmogleínas con elgrado de afectación cutáneo-mucoso. Material y métodos: Se obtuvieron 117 determinaciones en 26 pacientes con pénfigo y 29 determinaciones en pacientes con otras enfermedades ampollosas como grupo control. Medimos anticuerpos antisustancia intercelular por inmunofluorescencia indirecta y anticuerpos antidesmogleína 1 y 3 por ELISA. También se midieron las cifras de anticuerpos antes y después de terapias como las inmunoglobulinas intravenosas y plasmaféresis. Resultados: La determinación de anticuerpos por ELISA frentea desmogleínas 1 y 3 es más sensible que la inmunofluorescencia indirecta. No encontramos diferencias en cuanto a especificidad. Los niveles de anticuerpos son paralelos a la actividad clínica. Estos niveles no descienden inmediatamente tras la terapia con inmunoglobulinas intravenosas.
Nowadays diagnostic criteria of pemphigus include:clinical presentation with blisters and erosions, acantholisison the conventional histopathological examinationand detection of antibodies on affected skin (directimmunofluorescence) or serum (indirect immunofluorescence). Objective: The aims of this study are to compare sensibility and specificity between the ELISA method and the indirect immunofluorescence test (IIF)and to investigate a possible correlation between desmoglein titers (detected by ELISA) and clinical severity. Materials and methods: 26 patients with pemphigus were included in the study. The control group included 29patients with other bullous diseases. In every patient, antiintercellular substance antibodies were detected by the indirect immunofluorescence test while anti-desmoglein1 and 3 antibodies were titered by ELISA. In addition, titers of antibodies were measured before and aftertherapy with intravenous immunoglobulins and plasmapheresis. 117 determinations were obtained frompatients with pemphigus and 29 from the control group.Results: ELISA detection of antibodies against desmoglein1 and desmoglein 3 is a more sensitive method than the indirect immunofluorescence test. No difference inspecificity has been found. There is a positive correlation between titers of antibodies and clinical activity. Intravenous immunoglobulin therapy does not induceimmediate tapering of antibody titers.