Erythema elevatum diutinum as a first clinical manifestation for diagnosing HIV infection: case history

Abstract

CONTEXT: Erythema elevatum diutinum is a chronic and rare dermatosis that is considered to be a variant of leukocytoclastic vasculitis. It is probably mediated by immune complexes. It is generally associated with autoimmune, neoplastic and infectious processes. Recently, it has been added to the group of specific dermatoses that are associated with HIV. CASE REPORT: We report on the case of a patient who had erythema elevatum diutinum as the first clinical evidence for diagnosing HIV infection. Dapsone was used in the treatment of this patient, and partial regression of the lesions was achieved within 15 days, even before antiretroviral therapy was prescribed. CONCLUSION: When there is a diagnosis of erythema elevatum diutinum, HIV infection should be investigated, especially in atypical and exacerbated clinical manifestations.

Erythema Elevatum Diutinum in Human Immunodeficiency Virus Infected Patient

“…Even though the association of EED with HIV infection is infrequent, laboratory investigation for HIV should be conducted in conventional cases, and especially for cases with atypical and exacerbated clinical manifestations [2]. The EED lesions associated with HIV infection have been described as nodular with palmar/plantar involvement with greater numbers of lesions present at an earlier age.…”

“…EED is also easily misdiagnosed as Kaposi's sarcoma or bacillary angiomatosis, but the histopathological features are diagnostic [2,4,5]. Histopathological evaluation of the lesion is essential for differentiating EED from Kaposi's sarcoma or bacillary angiomatosis.…”

“…Re cently, an association of EED with HIV infection had been reported [2]. EED is diagnosed by the use of a lesion biopsy with histological findings including leukocytoclastic vasculitis, perivascular infiltrate (consisting mainly of polymorphonuclear neutrophils), nuclear dust, and to a lesser extent macrophages, lymphocytes and eosinophils [3].…”

A case of extensive erosive and bullous erythema elevatum diutinum in a patient diagnosed with human immunodeficiency virus (HIV)

“…The older the lesions, the more fibrotic they are; occasionally, they develop extracellular cholesterosis leading to a xanthomatous appearance, which is commonly seen in men in their fourth to sixth decades 2 . It is an immune complex‐mediated vasculitis resulting from chronic antigen exposure and is associated with celiac disease, streptococcal infections, monoclonal IgA gammopathies, hematological malignancies, cryoglobulinemias, rheumatoid arthritis, testicular and prostate carcinomas, relapsing polychondritis, etc 3 . There are abnormalities in neutrophil migration in response to bacterial peptides and IL‐8.…”

Erythema elevatum et diutinum in a young man coexisting with autoimmune polyglandular syndrome type 3 – case report

“…Nierzadko po zgłoszeniu się pacjenta do lekarza z powodu zmian skórnych o charakterze EED wykrywane są także inne schorzenia. Potwierdzono współwystępowanie EED z chorobami hematologicznymi (IgA paraproteinemią, szpiczakiem mnogim, mieszaną krioglobulinemią, czerwienicą prawdziwą, białaczką włochatokomórkową, przewlekłą białaczką limfatyczną, zespołem hipereozynofilowym, IgA gammapatią, chłoniakiem B-ko--mórkowym, anemią autoimmunohemolityczną), reumatologicznymi (reumatoidalnym zapaleniem stawów, układowym toczniem rumieniowatym, ziarniniakowatością z zapaleniem naczyń), endokrynologicznymi (cukrzycą typu 1, chorobami tarczycy), gastroenterologicznymi (celiakią, chorobą Leśniowskiego-Crohna, wrzodziejącym zapaleniem jelita grubego), nowotworami i chorobami infekcyjnymi (zakażeniem HIV, HBV, HCV, przewlekłymi nawracającymi infekcjami, gorączką reumatyczną, gruźlicą) [2,3,[9][10][11][12][13][14][15][16]. Z tego powodu w przypadku potwierdzenia rozpoznania EED należy wykonać badania dodatkowe w celu wykluczenia współwy-stępowania innych schorzeń.…”