Hemorrhagic Skin Nodules and Plaques: A Diagnostic Clue to Underlying Primary Plasma Cell Leukemia.

Plasma cell leukemia (PCL) is a rare lymphoproliferative disorder characterized by a malignant proliferation of plasma cells (PC) in blood and marrow. Cutaneous involvement is very rare in PCL. We present the case of a 45-year-old lady who presented with multiple hemorrhagic nodules and plaques in the skin. Her total leucocyte count was 2,00,200/cmm with 85% abnormal plasmacytoid cells in peripheral smear. Biopsy of the skin lesions revealed diffuse infiltration by plasma cells with 'choked' blood vessels. A diagnosis of plasma cell leukemia with cutaneous involvement was made. On the second day of admission, the patient expired probably because of intracranial bleed due to thrombocytopenia. Post-mortem bone marrow and liver biopsy also showed diffuse infiltration by plasma cells. Monoclonality of the cells was proven by demonstrating the production of only kappa light chains.

Long-term outcome of HIV-infected patients treated at a tertiary care hospital in southern India.

BACKGROUND: In India, the data are scanty on long-term outcome of patients with HIV/AIDS treated with first-line antiretroviral therapy. METHODS: We retrospectively studied the first 100 patients enrolled for antiretroviral therapy between February 2006 and March 2007 at Jawaharlal Institute of Postgraduate Medical Education and Research, a tertiary care hospital in southern India. Adherence, side-effects and clinical status were recorded at follow-up visits. The outcome measures were immunological recovery, attrition rate and first-line failure rate. First-line failure was defined on the basis of WHO clinical and immunological criteria. RESULTS: The median age of the patients was 36 years. The median baseline CD4 count was 117 cells/cmm. After a median follow-up of 44 months, of the initial 100 patients, 41 patients continued to be on follow-up, 10 patients had died and 41 patients had been lost to follow-up. The attrition rate was 20 per 100 patient-years. Fifty-five patients received >6 months of antiretroviral therapy; of these, 36 patients continued to have good immunological status with a median CD4 count of 548 cells/cmm after a median follow-up of 62 months. The first-line failure rate was 6.12 per 100 patient-years. CONCLUSION: The initial loss of patients to follow-up is a matter of concern particularly when durable improvement in immunological status is achievable if patients with HIV/AIDS can continue to be on long-term antiretroviral therapy.