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Published on: December 3, 2019
Papulonecrotic tuberculid in an HIV-positive patient.
Victoria Akhras1, Gill McCarthy
1Department of Dermatology, St George's Hospital, Blackshaw Road, London SW17 0QT, UK. vakhras@hotmail.com
International Journal of STD & AIDS
|September 6, 2007
Summary
A 33-year-old man with HIV developed a papular rash and systemic symptoms, diagnosed as papulonecrotic tuberculid. Treatment with quadruple therapy resolved the condition, highlighting immune system responses in HIV.
Area of Science:
- Dermatology
- Infectious Diseases
- Immunology
Background:
- Human Immunodeficiency Virus (HIV) infection can present with diverse mucocutaneous manifestations.
- Papulonecrotic tuberculid is a rare cutaneous reaction to tuberculosis, often seen in immunocompromised individuals.
Observation:
- A 33-year-old HIV-positive male presented with a two-year history of a non-itchy papular eruption.
- Associated symptoms included night sweats, headaches, memory impairment, and weight loss.
- Physical examination revealed erythematous papular lesions with necrotic centers on the face, arms, and torso.
Findings:
- Skin biopsy confirmed papulonecrotic tuberculid.
- Polymerase chain reaction (PCR) detected mycobacterial DNA, despite negative cultures and absent acid-fast bacilli.
- Quadruple therapy led to the resolution of the rash and systemic symptoms.
Implications:
- This case illustrates paradoxical immune system activation in HIV patients.
- Emphasizes the diagnostic importance of skin biopsy for unexplained systemic symptoms and rash in HIV.
- Highlights the need for a broad differential diagnosis in HIV-associated dermatological conditions.
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