Progressive supravenous granulomatous nodular eruption in a human immunodeficiency virus-positive intravenous drug user treated with highly active antiretroviral therapy

Abstract

We describe a 41-year-old human immunodeficiency virus-infected woman with a previous history of intravenous drug abuse, who developed multiple linear nodules following the superficial veins on both arms. Histopathological examination disclosed a dermal histiocytic inflammatory reaction with sarcoid-like granuloma formation occasionally showing an intracytoplasmic refractile material in the histiocytic cells. Nodular lesions developed progressively after starting on highly active antiretroviral therapy (HAART) which increased her CD4 cell count and suppressed her viral load. The appearance of latent inflammatory or autoimmune disease following HAART is a well-recognized phenomenon. We consider that this peculiar 'progressive supravenous granulomatous nodular eruption' should be included within the spectrum of the so-called immune reconstitution inflammatory syndrome.

Superficial Thrombophlebitis: A New Clinical Manifestation of the Immune Reconstitution Inflammatory Syndrome in a Patient With HIV Infection

“…In that case, the antigen implicated was a foreign body in relationship with previous addiction to intravenous drugs. 2 Histopathologic differential diagnosis of our case includes the so-called nodular granulomatous phlebitis. 10 This entity is now considered a fourth type of tuberculid, because the lesions develop in patients with hypersensivity to purified protein derivate, but without active tuberculosis.…”

“…In our literature review, we have only found one previously described case of panniculitis as clinical manifestation of IRIS, but in that patient the panniculitic process was interpreted as the result of worsening of an infectious disease or as a foreign body granuloma reaction. 2 We report the first case of superficial thrombophlebitis as a clinical manifestation of IRIS.…”

Cutaneous Colesional Acquired Immunodeficiency Syndrome Associated Kaposi Sarcoma and Cryptococcosis

“…25,26 The granulomatous component may be noninfective in origin, encompassing foreign body granulomas, granuloma annulare, and an immune host response to tumor cells, tumor substances, or to chemotherapeutic agents. [27][28][29][30] Such immune granulomas are sarcoidal in type, commonly associated with carcinomas, and lymphomas. 27 Described extremely rarely in sarcomas, 27 sarcoidal granulomas have been described once, to date, in classic KS.…”

Foreign Body Granulomas

“…One of them consisted of multiple, linear nodular lesions that develop at cutaneous intravenous drug injection sites and that may mimic polyarteritis nodosa, false aneurysms, and lymphatic spread of infections. 77 Histopathologically, these lesions show a sarcoidal granulomatous reaction to extravasated suspended drug particles in which inert material has been identified. 77 An IRISassociated foreign body granulomatous reaction has also been described in tattoos and in tribal scars containing long-standing burnt carbon.…”

“…77 Histopathologically, these lesions show a sarcoidal granulomatous reaction to extravasated suspended drug particles in which inert material has been identified. 77 An IRISassociated foreign body granulomatous reaction has also been described in tattoos and in tribal scars containing long-standing burnt carbon. 78 It has been hypothesized that a highly active antiretroviral therapy-augmented T-helper response with macrophage activation via interleukin 2 and interferon delta is responsible for these granulomatous reactions as an expression of IRIS.…”