Recognition of Dual or Multiple Pathology in Skin Biopsies from Patients with HIV/AIDS

Abstract

A large percentage of patients with HIV/AIDS will develop dermatological complications. Consequently, all practising clinicians and pathologists in regions with a high prevalence of HIV/AIDS must be familiar with the diverse cutaneous manifestations of the disease. This paper highlights the fact that biopsy material in this clinical context may occasionally reveal more than one pathological process. The potential spectrum includes two or more infections in a single skin biopsy (e.g., herpes simplex and cytomegalovirus infection), neoplastic lesions containing infective organisms (Kaposi sarcoma (KS) and cryptococcosis), dermatoses in association with neoplastic lesions (e.g., KS and interface dermatitis), or more than one dermatosis in a given specimen (e.g., papulopruritic eruption and nodular prurigo). Rare biopsies may even demonstrate triple pathology. The importance of careful examination of skin biopsies in this clinical context is emphasised. Failure to recognise an undiagnosed concomitant opportunistic infective pathogen could have potentially disastrous consequences for the patient.

Kaposi’s sarcoma, a South African perspective: Demographic and pathological features

“…As highlighted by Ramdial et al, [17] adequate investigation of granulomatous inflammation for confirmation of concomitant M. tuberculosis is crucial in highlighting possible multidrug resistance and non-compliance. The review article by Grayson [18] addressed concomitant pathology in cutaneous KS. Our CHBAHbased study documents concomitant pathology occurring in extracutaneous KS biopsy specimens.…”

Microscopic diversity in oral Kaposi sarcoma

“…28 The occurrence of co-existent infections, dermatoses and neoplasms has been described in cutaneous KS and to a lesser extent in OKS. [28][29][30][31][32][33] Twenty-five cases in this series showed co-existent pathology, most commonly in the form of superficially invasive candidiasis. This is not unexpected, considering oral candidiasis represents the most frequent intra-oral manifestation of HIV, regardless of stage.…”

Human Cytomegalovirus (HCMV) Infection in Sub-Saharan Africa

“…The most common presentation of HCMV infection in HIV-infected patients is HCMV pneumonia, where co-infection with other respiratory pathogens such a tuberculosis and Pneumocystis jirovecci, is almost ubiquitous [50,60]. HCMV is an important HIV co-infection, also linked with a range diseases including meningitis [62], encephalitis [63], psychological disorders [64], malaria [65], various dermatological conditions [66,67] and those affecting mucosal epithelia [68,69], hypoadrenalism [70], adrenalitis [71], gastritis [72,73] and other herpesvirus infections [74]. There has been a huge (possibly disproportionate) focus on HCMV as a cause of HIV-associated retinitis.…”