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Pruritic papular eruptions and candidiasis due to HIV infection
S Uchigasaki1, S Baba, H Kakinuma
1Department of Dermatology, Surugadai Nihon University Hospital, Tokyo, Japan.
Abstract:
We present two patients with refractory papular eruptions and severe candidiasis. Both of them are positive for treponema pallidum and have suffered from pruritic papular eruptions (PPE) that had resisted therapy for years. Also, candidiasis appeared in the mouth, at intertriginous sites, and on the feet. The clinical features suggested immunodeficiency, and HIV tests were positive. Histologically, the specimen from the PPE lesion showed perivascular and perifollicular mixed cell infiltration. The fungus was identified by both Parker-KOH-mount examination and mycologic culture as Candida albicans. The pruritic papules were healed almost completely with oral antihistamine and topical corticosteroid treatment, and the candidiasis mostly disappeared after treatment with topical antifungal agents alone. We learned from these two cases that refractory PPE and severe candidiasis indicate a need for HIV testing.
Insights
Two patients with persistent, itchy skin rashes and severe fungal infections were diagnosed with HIV. These symptoms, particularly refractory pruritic papular eruptions and candidiasis, can signal underlying immunodeficiency and warrant HIV testing.
Area of Science:
- Dermatology
- Infectious Diseases
- Immunology
Background:
- Pruritic papular eruptions (PPE) and severe candidiasis can be indicative of underlying immunodeficiency.
- Syphilis (Treponema pallidum) coinfection can complicate dermatological presentations.
Observation:
- Two patients presented with refractory PPE and severe mucocutaneous candidiasis.
- Clinical presentation suggested significant immunodeficiency, confirmed by positive HIV tests.
- Histopathology of PPE lesions revealed perivascular and perifollicular inflammation.
Findings:
- Candida albicans was identified as the causative agent of candidiasis.
- PPE responded well to topical corticosteroids and oral antihistamines.
- Candidiasis resolved with topical antifungal therapy.
Implications:
- Refractory PPE and severe candidiasis are potential indicators for HIV screening.
- Early detection of HIV is crucial for managing associated opportunistic infections.
- Integrated dermatological and infectious disease management is vital for patients with complex presentations.