A Case of Symptomatic Primary HIV Infection

Abstract

A 30-year-old homosexual Japanese man had fourteen days of fever, malaise, appetite loss, sore throat, and four days of diarrhea and slightly congested eyes before he developed a skin eruption. He presented with measles-like exanthems on his face, trunk, and extremities. Deep red enanthems were seen on his left buccal mucosa opposite the premolar teeth, and whitish enanthems were seen on the buccal and gingival mucosa. HIV RNA was detected at the high concentration of 5.8 x 10(6) copies /ml in his serum. Cerebrospinal fluid examination revealed aseptic meningitis with 5,488 copies /ml of HIV RNA. Anti-HIV 1 antibodies against Gp160 and p24 tested by Western blot assay showed seroconversion on day 5 of his admission, seven days after he developed the skin eruptions. The fever lasted for three weeks from the initial onset, and the skin eruptions lasted for twelve days. Histopathologically, a mononuclear cell infiltration was seen mainly in the upper dermis surrounding small vessels and sweat ducts, with CD8+ cytotoxic T lymphocytes predominant. Additionally, CD1a+ putative interdigitating dendritic cells had also infiltrated perivascularly, and were surrounded by CD8+ and CD4+ T cells. In situ hybridization study failed to detect HIV products in skin biopsy specimens. Our findings suggested that CD8+ T cells and their interaction with CD1a+ dendritic cells in the skin may be important in inducing skin manifestations in acute HIV infections.

Serum IgG and lymphocyte counts are useful for the early detection of infection in patients receiving bendamustine-rituximab therapy

“… 8 , 22 , 23 Skin reactions are associated with a decreased number of CD4+ T cells. 10 , 24 - 26 Our study suggested that patients with skin reactions caused by bendamustine had an immunosuppressive status with lymphopenia. Patients who develop skin reactions due to BR therapy need to be carefully followed up because they are in an immunosuppressive state.…”

Cutaneous mastocytosis in human immunodeficiency virus: an unfortunate coincidence?

“…The face, forehead and scalp are involved in most cases, but the eruption is sparse or absent at the periphery of the limbs 2 . Biopsy generally shows a rather nonspecific mononuclear cell infiltrate, mainly in the upper dermis surrounding small vessels and sweat ducts, composed of a mixture of CD4+ and CD8+ T lymphocytes with CD68+ histiocytes/dendritic cells and possibly some CD1a+ dendritic cells 2–4 . We have been unable to find reports of cutaneous mast‐cell infiltration associated with HIV seroconversion.…”

Nevirapine-induced Stevens-Johnson syndrome following HIV postexposure prophylaxis

“…The sexual history and presentation mandated the need for investigations to exclude an infective aetiology, including sexually transmitted infections. Rash is well described in acute HIV infection, which was high on the list of differential diagnoses;4 the palmar distribution of the rash5 required the exclusion of secondary syphilis, although the time from exposure to illness did not support this. The clinical context of the case supported by the extensive negative infection screen made the diagnosis of the SJS secondary to nevirapine the more likely diagnosis in this patient.…”