Finger pad tophi.

Hyperuricemia and gout are known to occur in patients receiving diuretic therapy. More recently recognized, however, is the occurrence of tophaceous gout in patients treated with cyclosporine. We report a 57-year-old man with normal renal function who was started on cyclosporine immediately after undergoing bilateral lung transplantation. Six months later, he developed progressive renal insufficiency and hypertension. In the following four months (10 months after starting his immunosuppressant medication), he presented with a symmetrical distribution of tophi on his finger pads. Seven previous cases of finger pad tophi have been reported and are reviewed.

Acute varicella zoster with postherpetic hyperhidrosis as the initial presentation of HIV infection.

A 31-year-old man presented with acute pain in his left arm and hemorrhagic vesicles that followed his left 8th cervical nerve. A diagnosis of herpes zoster was made, and the patient was treated with valacyclovir. He refused testing for antibodies to HIV because he denied being at risk. Two months later he returned with postherpetic neuralgia and postherpetic hyperhidrosis in the distribution of the vesicles, which had since resolved. Serology for HIV at this visit was positive, and the patient admitted to having sexual relations with prostitutes. Six months later the patient was being treated with triple antiretroviral therapy, and all signs and symptoms of postherpetic zoster had resolved. This case report documents the need for HIV testing in patients with unusual presentations of herpes zoster even if they initially deny being at risk.

Current antiretroviral therapy in the treatment of HIV infection.

Since the introduction of the first antiretroviral agent, zidovudine (AZT) in 1987, much progress has been made in the chemotherapy of the human immunodeficiency virus (HIV). Currently nine antiretroviral agents are approved for the treatment of individuals infected with HIV or with the acquired immune deficiency syndrome (AIDS). These medications are routinely divided into three categories: nucleoside analogues, non-nucleoside analogues, and most recently, protease inhibitors. As our knowledge of the pathogenesis of HIV increases, new antiretroviral agents become available, and advanced techniques develop to more accurately assess the degree of viral burden in an individual's blood, recommendations regarding treatment initiation and choice of antiviral agents are continually changing. The current general consensus is to "hit early" and "hit hard." Early initiation of treatment with multidrug therapy in all individuals infected with HIV is recommended by most experts with the common goal of reducing viral load to a nondetectable level. Numerous studies have shown the increased efficacy of multidrug therapy over monotherapy, however trials are still continuing to determine combination therapies which will provide the maximum benefit.

Linear basal cell carcinomas: report of multiple sequential tumors localized to a radiotherapy port and review of the literature.

Linear basal cell carcinoma, an uncommon variant of basal cell carcinoma, was first described in 1985. The cases of eight additional patients with this morphologically distinctive variant have been published subsequently. We describe a woman who sequentially developed three linear basal cell carcinomas located within her radiotherapy port. Including our patient, 12 linear basal cell carcinomas have been reported in 10 patients (4 men and 6 women) ranging from ages 40 to 77 years. The tumors were located most often on the head and neck (9 cancers); other sites involved the shoulders (2 cancers) and posterior thorax (1 cancer). All of the tumors were excised without recurrence. Various mechanisms have been postulated to account for this morphologic variant of basal cell carcinomas including a Koebner phenomenon or limited lateral spread of the cancer secondary to dermal fibrosis, or both.

The impact of the human immunodeficiency virus on the human papillomavirus epidemic.

OBJECTIVE: To examine how human immunodeficiency virus (HIV) infections affect human papillomavirus (HPV) infections. DATA SOURCE: MEDLINE was searched for relevant publications. STUDY SELECTION: All studies dealing with both HIV and HPV infections were reviewed. DATA EXTRACTION: Publications with clinically relevant data were included in the present analysis. DATA SYNTHESIS: A critical analysis of the data described in these articles was performed without formal statistical calculations. CONCLUSIONS: Results revealed that immunocompromised individuals have an increase prevalence of HPV-associated lesions and neoplasia. Immunosuppressed patients (eg, those who have undergone transplantation or those who have been treated with chemotherapy and/or radiation therapy) have a higher rate of HPV infections. Human papillomavirus and HIV appear to be important cofactors for developing cervical and anal dysplasia and carcinoma. Individuals who are seropositive for HIV have an increased prevalence of HPV infections, a more rapid progression of the disease, and a higher number of invasive carcinomas. The presence of HPV DNA, extent of disease, and potential for malignant transformation also appear to correlate with the degree of immunosuppression. Individuals with a CD4 cell count under 0.20 x 10(9)/L (< 200/microliters) are at greatest risk. Treatment options for immunocompromised individuals remain similar to those for normal hosts; however, immunocompromised individuals have a much higher rate of recurrence. Improved immunostimulant and/or antiviral therapy is needed for HIV-seropositive individuals with widespread genital involvement. Control of both the HPV and the HIV epidemics involves at least 3 levels of intervention: better antiviral drugs, frequent monitoring for disease progression in infected persons, and better education to reduce spread of the disease.