Sudden Onset of Papular Elastorrhexis After Immunologic Recovery in a Boy with Human Immunodeficiency Virus

Papular elastorrhexis (PE) is an uncommon elastic tissue disorder clinically characterized by the onset of asymptomatic flesh-colored to whitish papules over the trunk and upper limbs in children. Its etiology remains unknown, although isolated familial cases have suggested that acquired and inherited forms of the disease may exist. We present the case of a 13-year-old boy with human immunodeficiency virus who presented with such lesions after immunological recovery from very low CD4⁺ counts after introducing highly active antiretroviral therapy. Because neutrophils and macrophages are implicated in elastin metabolism and degradation pathways, immune dysregulation might be another etiologic factor to be considered in this rare disease.