Pyoderma gangrenosum(PG) is a rare ulcerating inflammatory neutrophilic dermatosis. Genital involvement has been rarely reported. We report such a case of 24- year- old, male patient living with HIV/AIDS(PLHIV) who presented with progressive genital ulceration, not responding to oral antibiotics and aciclovir, gradually increasing in size over 15-18 months. Repeated biopsies showed acute on chronic inflammation. The lesion partially responded to oral and topical corticosteroids but soon increased in size after tapering the dosage of the steroids.Then patient was given Imiquimod 5% cream to be applied over the lesion once daily for 2-4 weeks. Lesion cleared completely in 4 weeks and is in remission since last 6 months. The case report highlights the successful use of topical Imiquimod 5% cream in the treatment of penile PG.
A 35-year-old HIV-reactive female presented to us with multiple erythematous plaques on her face, trunk, and limbs, since five days. Bilateral ulnar and lateral popliteal nerves were thickened and tender. Antiretroviral drugs (d4T, 3TC, NVP) had been started one month prior. Slit skin smear was negative. Skin biopsy from infiltrated lesions showed ill-defined, noncaseating epitheloid granulomas, confirming the diagnosis of borderline tuberculoid leprosy, with reversal reaction. In the setting of the recent Antiretroviral Therapy (ART) this is considered clinically as Immune Reconstitution Inflammatory Syndrome (IRIS).
A venous lake, sometimes referred to as senile hemangioma of the lips is usually a solitary, non-indurated, soft, compressible, blue papule occurring due to dilatation of venules. It is commonly found on sun-exposed surfaces of the face and ears. We describe a 46 year-old male who presented with this clinical picture on the lower lip.
Context:
Sexually transmitted infections (STIs) have a well-established synergistic relationship with human immunodeficiency virus (HIV) infection. Coinfection with HIV and STI can increase the probability of HIV transmission to an uninfected partner by increasing HIV concentrations in genital lesions, genital secretions, or both. Concurrent HIV infection alters the natural history of the classic STIs.
Aims:
The aim was to study the current scenario of STIs with HIV co-infection, and to recognize different manifestations of STIs than the classical presentation in people living with HIV/AIDS (PLHIV).
Settings and Design:
It was an open, cross-sectional, descriptive study carried out in the setting of state government hospital with attached antiretroviral therapy referral center.
Subjects and Methods:
The sample size of the study was duration based (30 months).
Inclusion Criteria:
All PLHIV presenting to the department of dermatology with STIs were included in the study.
Exclusion Criteria:
Non-STI causes of genital ulceration were excluded in the study.
Results:
The study includes total (
n
= 484) patients living with HIV/AIDS, prevalence of different STIs was in the following order, herpes simplex virus infections 24.17%, human papillomavirus infections 8.88%, molluscum contagiosum 7.43%, secondary syphilis 4.33%, gonorrhea 1.85%, chancroid 1.44%, and granuloma inguinale 0.41%. Of all the patients with herpes simplex virus infections, 45.6% (
n
= 57) had multiple recurrences (>6/year). The incidence of mixed STI was 17.29% in the present study.
Conclusions:
The study represents decreasing trends in bacterial STIs and the rise of viral STIs. Atypical presentations of classic STIs were more frequent than non-HIV-infected individuals.
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