Cutaneous manifestations of mycobacterial infection in patients with AIDS

Abstract

Summary We report three cases of mycobacterial infection of the skin in HIV‐positive individuals, in whom the diagnosis was not suspected until microbiological and histological investigations were performed.

Cutaneous Mycobacterium Avium Intracellulare Infection in an HIV+ Patient Mimicking Histoid Leprosy

“…MAI infections manifest in 18 to 27% of AIDS patients with a significantly higher proportion noted at autopsy. 9 Two of the four patients with HIV originally described by Gotttleib et al 10 were found to have previously undiagnosed, disseminated MAI infection at post mortem examination. Although cutaneous involvement in AIDS patients remains uncommon, it rarely occurs without concomitant bacteremia and is considered presumptive evidence of a disseminated infection.…”

“…Although cutaneous involvement in AIDS patients remains uncommon, it rarely occurs without concomitant bacteremia and is considered presumptive evidence of a disseminated infection. 1,9,11 The clinical manifestations of cutaneous disease are protean and include nodules, erythematous papules, ulcers, pustules, abscesses, folliculitis, panniculitis, infiltrated plaques, verrucous lesions, and draining sinuses. 1,8 Lesions typically arise following traumatic implantation of the microbe in the skin, cervical lymphadenitis with cutaneous extension of the infection, or disseminated disease with multiple nodules and ulcers.…”

Unusual Cutaneous Manifestations of Miliary Tuberculosis

“…In their review published in 1968, Schermer et al [4] described a total of 15 such cases in adult patients. Since then, 22 documented cases have been reported, mainly in the last 8 years [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Most of them were patients with AIDS [14][15][16][17][18][19][20][21][22][23][24].…”

Cutaneous miliary tuberculosis in two patients with hiv infection

“…22 Cutaneous miliary tuberculosis in the settings of HIV infection as well as other forms of immunodepression are typically characterized histologically by a lack of granulomatous response and a high bacillary load-analogous to lepromatous leprosy (Table I). 7,[11][12][13][14][15][16][17][18][19][20][21][22] Histological features include an acute inflammatory infiltrate composed exclusively of neutrophils, focal superficial dermal necrosis, and without true caseating granulomas (Table I). 7,8,22 Cutaneous miliary tuberculosis in HIV patients has often been a harbinger of rapid clinical progression and frequent patient demise.…”

“…Since that time, 16 additional cases of disseminated miliary tuberculosis have been described in patients coinfected with HIV, including the two reported herein (Table I). [13][14][15][16][17][18][19][20][21][22] The two factors hypothesized to be responsible for the resurgence of this rare skin manifestation of disseminated tuberculosis are severe immune dysregulation caused by HIV infection and increasing emergence of multidrug-resistant strains of M tuberculosis. 22 As in many other case reports, both of our patients had advanced HIV infection as reflected by severe T-cell depletion (CD4 cell count Ͻ100/mm 3 ) and high viral loads.…”