Papular pruritic eruption as a clinical indicator of an undiagnosed AIDS patient: A case report
Keywords:
papular pruritic eruption, HIV, AIDS, undiagnosedAbstract
Cutaneous disorders are one of the most common complications of patients with Human Immunodeficiency Virus (HIV) infections and acquired immunodeficiency syndrome (AIDS). The clinical manifestation of these cutaneous disorders’ ranges from infections, malignancies, and other inflammatory conditions that can be distinguished based on the severity of infection through assessment of the number of CD4 lymphocyte cells. The misdiagnosis rate of these cutaneous disorders is high, particularly in patients with unclear HIV status or undiagnosed HIV infections. Papular pruritic eruption (PPE) is one of the cutaneous manifestations of HIV that occur mostly in patients with a low count of lymphocyte CD4 cells (<200 cells/uL). We report a case of a 49-year-old male patient with PPE that was initially diagnosed with prurigo nodularis with no improvement after topical potent corticosteroid treatment. A more thorough history taking, physical examination, and confirmation through histopathology examination revealed that the patient was an undiagnosed AIDS patient with a total lymphocyte CD4 cell count of 45 cells/uL with PPE. The patient was successfully treated using a combination of antiretroviral (ARV), oral antihistamines, and topical corticosteroids with significant clinical improvements, prompting physicians to be more aware of the possibility of PPE when faced with unspecific dermatitis / prurigo-like clinical manifestation with no improvement after conventional corticosteroid treatment.References
Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach: World Health Organization; 2021.
Laporan Perkembangan HIV AIDS dan Penyakit Infeksi Menular Seksual (PIMS) Triwulan I Tahun 2021: Kementerian Kesehatan Republik Indonesia; 2021 [Available from: https://siha.kemkes.go.id/portal/files_upload/Laporan_TW_I_2021_FINAL.pdf.
Altman K, Vanness E, Westergaard RP. Cutaneous manifestations of human immunodeficiency virus: a clinical update. Curr Infect Dis Rep. 2015;17(3):464.
Lewis D, Feldman S. Cutaneous manifestations of human immunodeficiency virus/acquired immunodeficiency syndrome: A comprehensive review. J Dermatol Surg. 2020;24(2):66-73.
Guidelines on the treatment of skin and oral HIV-associated conditions in children and adults: World Health Organization; 2014.
Lipworth AD, Freeman EE, Saavedra AP. Cutaneous Manifestations of HIV and Human T-Lymphotropic Virus. In: Kong S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, McMichael AJ, et al., editors. Fitzpatrick's Dermatology 9th Edition. 2. New York: McGraw-Hill; 2019. p. 3107-34.
Mirnezami M, Zarinfar N, Sofian M, Botlani Yadegar B, Rahimi H. Mucocutaneous Manifestations in HIV-Infected Patients and Their Relationship to CD4 Lymphocyte Counts. Scientifica. 2020;2020:7503756.
Bellavista S, A DA, Infusino SD, Trimarco R, Patrizi A. Pruritic papular eruption in HIV: a case successfully treated with NB-UVB. Dermatol Ther. 2013;26(2):173-5.
Gao Z, Zeng X, Hu L, Huang S, Li Y, Du X. Papular pruritic eruption in HIV-infected patient: Clinical presentation and noninvasive findings. Skin Res Technol. 2022;28(5):759-61.
Eisman S. Pruritic papular eruption in HIV. Dermatol Clinics. 2006;24(4):449-57.
Vandormael A, de Oliveira T, Tanser F, Bärnighausen T, Herbeck JT. High percentage of undiagnosed HIV cases within a hyperendemic South African community: a population-based study. J Epidemiol Community Health. 2018;72(2):168-72.
Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach: World Health Organization; 2016.
Kwara A, Flanigan TP, Carter EJ. Highly active antiretroviral therapy (HAART) in adults with tuberculosis: current status. Int J Tuberc Lung Dis. 2005;9(3):248-57.
Mowla MR, Manchur MA, Islam AQMS, Maurer T. Cutaneous Manifestations of HIV/AIDS in the Era of Highly Active Antiretroviral Therapy: Evidence from Bangladesh. Int J Dermatol Venereol. 2022;5:1.
