Drug-induced systemic lupus erythematosus in a child living with HIV.

Pediatric systemic lupus erythematosus (SLE) constitutes approximately 10% of SLE cases. The diagnosis and management of this condition remains to be a challenge in the pediatric population. The distinguishing clinical features are less pronounced male-to-female ratio, more organ damage, and higher disease activity compared to adult-onset disease. Drug-induced lupus erythematosus is rare in children. We report a case of drug-induced SLE in a child on antiretroviral therapy.

Clinical and histopathological aspects of lichenoid dermatitis in patients of retroviral diseases.

Context: Lichen planus (LP) is known to be associated with viral infections such as hepatitis B and C, but its association with HIV is rarely reported. Lichenoid drug eruptions have been implicated as the side effects of anti-retroviral therapy. Aims and Objectives: The aim of this study is to study demographics, clinical, histological, and immunological profile of the HIV patients presenting with lichenoid dermatitis. Subjects and Methods: HIV patients presenting with LP such as lesions were evaluated with complete history and physical examination. Demographic profile of patients was studied with features such as age, sex, duration of disease, distribution of the lesions, CD4 count, concomitant medications, associated comorbidities, and response to the treatment. Results: Twenty-one HIV patients presenting with LP such as lesions were studied. Of these, 20 patients had LP and one patient had lichenoid drug reaction. The age of the patient ranged from 40 to 60 years with no sex predilection. The duration of lesions ranged from 15 days to 7 years. Eleven patients had simultaneous cutaneous and oral involvement, five patients had only oral involvement and four patients of LP and one patient of lichenoid drug reaction had only cutaneous lesions. All the patients were on antiretroviral therapy, mainly on lamivudine, zidovudine, and nevirapine. Almost all the patients had CD4 count of more than 250 at the time of presentation. One patient was diagnosed to have lupus erythematosus and LP overlap. Patients were treated with oral medications such as corticosteroids, methotrexate, and dapsone and topical medications such as corticosteroids and calcineurin inhibitors. Conclusions: The appearance of LP such as lesions in HIV patients is a rare occurrence with 11 cases of LP reported till date. Our case series of 20 patients will throw light on possible etiology and difficulties in the management of LP such as lesions in HIV patients.

Case series of rare nonvenereal vulvar dermatoses.

Nonvenereal vulvar diseases such as syringoma and vestibular papillomatosis can be difficult to differentiate from genital warts. Misdiagnosis of these conditions can lead to improper treatment without significant improvement and prolonged suffering. Histopathology may differentiate these conditions from sexually transmitted diseases and help in appropriate treatment. Here, we present case series of four rare vulvar diseases.

Management of Rhinophyma with Radio Frequency: Case Series of Three Patients.

Rhinophyma is the most common form of phymatous rosacea, typically seen in men. It may appear de novo (without preceding inflammatory changes) or occur in patients with preexisting papulopustular rosacea. It is characterized by slow, bulbous, reddish-purple, painless enlargement of lower two-third of nose with rugose peau d'orange surface resulting from the enlargement of the sebaceous glands and subcutaneous tissue, which does not resolve spontaneously. Though benign, it causes lot of cosmetic and psychological concern. Commonly used treatment modalities include debulking by surgical excision, electrosurgery, carbon dioxide laser ablation, cryosurgery, or dermabrasion. Here we report a case series of three patients with Grade 3 rosacea as per National Rosacea Society grading, treated by radio frequency with good improvement.

Metastatic squamous cell carcinoma of penis in an HIV-infected man presenting with cutaneous manifestations.

The incidence of penile squamous cell carcinoma (SCC) varies widely in different parts of the world. It is rare in Western countries but common in developing countries like India. The glans and foreskin are the most commonly affected sites. It can occur in two forms which have different evolution and prognosis. Exophytic papillary lesions have late and rare lymphatic spread and ulcero-infiltrating lesions are associated with rapid lymph node invasion and a poorer prognosis. Human immunodeficiency virus (HIV) is an aggravating factor for penile cancer and accelerates the progression of the disease. Cutaneous metastasis from penile SCC is rarely reported. Here, we report a case of metastatic SCC of the penis in a 51-year-old HIV-infected man who presented with cutaneous metastases in the inguino-pubic region with a hidden penile SCC.

Nodulo-ulcerative and erythrodermic secondary syphilis in human immunodeficiency virus-infected individuals.

Syphilis and human immunodeficiency virus (HIV) infections are both transmitted sexually. Co-infection of HIV and syphilis alters the course of both diseases. Clinical presentation of syphilis in patients of HIV may be atypical. HIV-infected individuals are at risk of developing lues maligna, which is characterized by nodulo-ulcerative lesions associated with severe constitutional symptoms. Erythroderma secondary to generalized papulo-squamous lesions of secondary syphilis is also uncommon. Here we report two cases of atypical presentations of secondary syphilis in HIV-positive patients.

In situ squamous cell carcinoma of male and female external genitalia.

In situ squamous cell carcinoma (SCC) of male and female genitalia can present as Bowen's disease (BD), erythroplasia of Queyrat, Bowenoid papulosis, Paget's disease, pseudoepitheliomatous keratotic, and micaceous balanitis. BD is SCC in situ. It affects both skin and mucous membranes and has the potential to progress to invasive SCC. BD can be found on any body site, including both sun-exposed and non-sun-exposed regions of the body. However, BD presenting on the genitalia is rare. Here, we present a report of three cases of in situ genital malignancies. Two females had BD, and one male had erythroplasia of Queyrat.

Chronic vulvovaginitis caused by Candida dubliniensis in an immunologically competent adult female.

Candida, a commensal dimorphic fungus, is the most common microorganism that causes opportunistic fungal infections worldwide. It can cause diseases ranging from superficial mucosal infections to disseminated, systemic life-threatening infections. Among Candida species, Candida albicans is the most common infectious agent. Nowadays, non- albicans Candida species are also emerging as significant pathogens. Candida dubliniensis has been implicated as a causative agent of oral candidiasis in HIV-infected individuals but has also been recovered from HIV non-infected individuals with oral candidiasis and rarely from the genital tract of women with vaginitis. Such cases have been under-reported due to phenotypic resemblance to C. albicans. The majority of C. dubliniensis clinical isolates tested to date have been susceptible to fluconazole, but they tend to develop resistance rapidly. Here, we report a case of chronic vulvovaginitis due to C. dubliniensis not responding to standard doses of fluconazole.

Surgical Management of Onychopapilloma, Onychomatricoma, and Subungual Osteochondroma: Case Series.

The clinical diagnosis of benign and malignant nail tumors can be difficult. Dermoscopy can provide a clue to the diagnosis but nail biopsy is the gold standard in establishing the diagnosis. Here, we report three cases of rare nail tumors, that is, onychopapilloma, onychomatricoma, and subungual osteochondroma, which were diagnosed on histopathology and managed surgically.

Metastatic Angiosarcoma of Lower Extremity.

Angiosarcoma (AS) is an uncommon malignant neoplasm characterized by rapidly proliferating, extensively infiltrating anaplastic cells derived from blood vessels. These are aggressive tumors and tend to recur locally, spread widely with high rate of lymph node and systemic metastases. They are more frequent in skin and soft tissue, head and neck being the most common sites. Here we report a case of metastatic AS affecting lower extremity in an elderly patient on a background of chronic lymphedema due to filariasis (Stewart-Treves syndrome).