Erythema elevatum diutinum in human immunodeficiency virus-infected patients - report of a case and review of the literature

Abstract

Erythema elevatum diutinum (EED) is a rare chronic disease of unknown origin, part of the spectrum of cutaneous leucocytoclastic vasculitis. A case of EED in a 32-year-old HIV-infected male patient, with no previous opportunistic infections and a CD4+ cell count of less than 200/mm3, is reported. Therapy with oral dapsone (100 mg/day for 15 days) resulted in clinical cure with no relapse after 6 months of follow-up. To our knowledge, only six cases of EED in HIV-positive patients have been reported to date. A brief review of these seven cases is described.

A case of myasthenia gravis accompanied by erythema elevatum diutinum and rheumatoid arthritis

“…Some reports suggest that EED is associated with recurrent bacterial infections [8], collagen vascular diseases (rheumatoid arthritis, systemic lupus erythematosus) [13], neoplastic diseases (prostate carcinoma, testicular lymphoma) [8,13], haematological abnormalities (multiple myeloma, myelodyspla-sia, IgA mono-or bi-clonal gammopathy, hairy cell leukaemia, mixed cryoglobulinaemia, polycythaemia vera) [13] and HIV infection [4].…”

“…Though the aetiology of EED remains unclear, immune complexes are thought to play a role [1,4]. It has been proposed that leukocytoclastic vasculitis is a small-vessel inflammatory disease mediated by immune complexes.…”

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

“…[13][14][15] There have also been reports of associations with rheumatic arthritis, 3,16,17 prostate carcinoma, 3,18 testicular lymphoma, 3 celiac disease, 19 Crohn's disease, 20 relapsing polychondritis 21 and, more recently, with HIV infection. [22][23][24][25] Among young males, exacerbated clinical states with nodular lesions seem to be correlated with HIV infection, in contrast with the clinical picture observed for the general population. 24,25 The EED skin lesions of this patient allowed the detection of HIV infection through laboratory investigation.…”

Erythema elevatum diutinum and plastic surgery Case report

“…However, EED lesions may not respond to dapsone, or if they do, recurrences are quite common [5,11,24,31,39]. It is possible that the marked fibrosis in late lesions may account for the lack of response to dapsone [8]. Some patients develop a reaction to dapsone and respond poorly to other medications, as seen in our patient.…”