Chronic diffuse dermatitis and hyper-IgE in HIV infection

Diffuse dermatitis and markedly elevated serum IgE concentrations were observed in three adult males who were seropositive for human immunodeficiency virus (HIV) antibody. The clinical features in common for these patients included 1) an adult onset of greater than 6 weeks' duration associated with pruritus, 2) T-helper (CD-4) cell depletion, 3) the lack of overt atopic disease, and 4) the lack of opportunistic infection (except oral thrush) and neoplasia. The mean serum IgE concentration was 5,959 (range: 4,930-6,260) IU/ml. Cutaneous involvement consisted of hyperpigmented papules with variable excoriations and lichenification. Zidovudine was administered to all 3 patients and was associated with cutaneous improvement. Serum IgE concentrations from 19 AIDS patients without cutaneous disease did not show significant elevations. These observations suggest that certain patients with HIV infection can manifest a unique hyper-IgE syndrome associated with diffuse cutaneous disease.