Lupus Masquerading as a Drug Reaction in HIV Infection.

An HIV-positive female on antiretroviral therapy (ART) presented with an annular eruption diagnosed as a drug reaction based on histology of a lichenoid dermatitis. She responded to oral steroid therapy and discontinuation, but progressed to develop features in keeping with cutaneous lupus. Although the antinuclear factor remained negative, her low serum complement levels, histology, and clinical features pointed to a diagnosis of subacute lupus in the setting of HIV infection. She responded well to antimalarial therapy and recommenced ART.

Peri-Umbilical Lymphangioma Circumscriptum Associated with Intra-Abdominal Lymphatic Malformations.

A 12-year-old African female presented with a 6-year history of relatively asymptomatic umbilical lesions. On clinical examination, the lesions were papillomatous, violaceous nodules and translucent papules with a serosanguineous discharge. The lesions emanated from the umbilicus and extended peri-umbilically. Histopathology confirmed a lymphangioma and MRI and CT imaging revealed multiple intra-abdominal lymphatic malformations. The patient was referred to plastic surgery for further management. Due to the extent of involvement, surgical resection was an option but currently the therapeutic approach is sclerotherapy with bleomycin.

An Update on Adverse Cutaneous Drug Reactions in HIV/AIDS.

BACKGROUND: The global mortality from HIV and the cutaneous burden of infective, inflammatory and malignant diseases in the setting of AIDS have significantly declined following the advent of highly active antiretroviral therapy. Regrettably, there has been a contemporaneous escalation in the incidence of adverse cutaneous drug reactions (ACDR), with studies attesting that HIV-positive individuals are a hundred times more susceptible to drug reactions than the general population, and advanced immunodeficiency portending an even greater risk. Several variables are accountable for this amplified risk in HIV. SUMMARY: Adverse reactions to trimethoprim-sulfamethoxazole are the most common, increasing from approximately 2-8% in the general population over to 43% amongst HIV-positive individuals to approximately 69% in subjects with AIDS. Antituberculosis drugs and antiretrovirals are also well-known instigators of ACDR. Cutaneous reactions range from mild morbilliform eruptions to severe, life-threatening manifestations in the form of Stevens-Johnson syndrome/toxic epidermal necrolysis. Histological features vary from vacuolar interface changes to full-thickness epidermal necrosis with subepidermal blister formation. A precipitous diagnosis of the ACDR, clinically and histologically if necessary, together with the isolation of the causative drug is critical. The identification process, however, is often complex and multifaceted due to polypharmacy and inconclusive data on which drugs are the most likely offending agents, especially against the background of tuberculosis co-infection. KEY MESSAGES: Whilst milder cutaneous reactions are treated symptomatically, severe reactions mandate immediate treatment discontinuation without rechallenge. Further studies are required to establish safe rechallenge guidelines in resource-limited settings with a high HIV and tuberculosis prevalence.