Peter Angritt

Cutaneous neoplasms in a military population of HIV-1-positive patients******

BACKGROUND In HIV-1-positive patients there have been no prospective studies that show an increase in cutaneous neoplasms. OBJECTIVE We observed HIV-1-positive patients to determine whether or not there was an increased incidence of cutaneous malignancies. METHODS A total of 724 HIV-1-positive patients were examined during a 36-month period for the development of cutaneous malignancies. RESULTS The most common cutaneous neoplasm found was Kaposis sarcoma, especially in patients with late-stage disease. Basal cell carcinomas were the next most frequent tumor. We have also seen three malignant melanomas and two squamous cell carcinomas. Five patients had malignant lymphoma. One patient had a primary lymphoma of subcutaneous soft tissue; in one patient multiple cutaneous lesions developed. CONCLUSION The distribution and prevalent types of cutaneous neoplasms in HIV-1-positive patients appear to differ from those found in other immunosuppressed populations. This may be the result of the different patterns and periods of immunosuppression in these patients and/or associated cocarcinogens to which these patients frequently are exposed.

A clinical and pathological comparison of the WHO and CDC case definitions for AIDS in Kinshasa, Zaïre: is passive surveillance valid?

Objectives:To compare the specificity of the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) case definitions for AIDS in autopsy cases from Zaïre. Setting:Mama Yemo Hospital and University Hospital morgues in Kinshasa, and Karawa Hospital in Equateur Region, Zaïre. Methods:Autopsy cases with a clinical diagnosis of AIDS on the death certificate or chart were studied. Evaluation included post-mortem HIV-1 serology, chart review for specific AIDS-related symptoms and signs, and application of WHO and CDC case criteria to the clinical and autopsy diagnoses. Results:Of the 68 diagnosed AIDS cases, 98% fulfilled WHO criteria for AIDS and 93% fulfilled both WHO and CDC criteria. All cases fulfilling both criteria were HIV-1-seropositive. Opportunistic infections accounted for 84% of CDC AIDS-defining conditions. Disseminated tuberculosis was the most frequent (41%) specific diagnosis; Pneumocystis carinii pneumonia was rare (<2%). Conclusions:There was good concordance between WHO and CDC case definitions. A diagnosis of AIDS on the chart or death certificate is adequate for surveillance purposes in this population.

Verrucous lesions secondary to DNA viruses in patients infected with the human immunodeficiency virus in association with increased factor XIIIa-positive dermal dendritic cells

BACKGROUND Hyperkeratotic lesions caused by varicella-zoster, herpes simplex, or cytomegalovirus occur in patients infected with human immunodeficiency virus type 1 (HIV-1). We have also observed this type of lesion with molluscum contagiosum. OBJECTIVES These cases were studied to determine whether there are any pathologic changes unique to these lesions. METHODS The cases were studied by routine microscopic examination and immunohistochemistry. RESULTS Each case showed changes diagnostic of the viral infection, which was confirmed by immunohistochemical stains for herpes simplex and cytomegalovirus. In the dermis there were fewer inflammatory cells than expected, but there was an increase in factor XIIIa-positive dendritic cells. CONCLUSION Varicella-zoster, herpes simplex virus, cytomegalovirus, and molluscum contagiosum can cause verrucous lesions in HIV-1-infected patients. These lesions may be related to an increase in factor XIIIa-positive dendritic cells.

Concurrent epidermal involvement of cytomegalovirus and herpes simplex virus in two HIV-infected patients

Although cytomegalovirus has previously been reported in cutaneous lesions of patients infected with the human immunodeficiency virus, these reports are not common despite the prevalence of this infection and the significant pathologic characteristics that it induces in HIV disease. Rare reports of possible epidermal involvement by cytomegalovirus have never been fully documented and have been believed by some to represent epidermal involvement by varicella-zoster and/or herpes simplex infections, with dermal involvement of cytomegalovirus. We present two cases of concurrent epidermal involvement by cytomegalovirus and herpes simplex virus documented by immunohistochemical studies and DNA hybridization studies and correlate this with the distinctive morphologic features seen in these two viral infections on routine staining.

Clinical and histopathologic features of hair loss in patients with HIV-1 infection☆

BACKGROUND Hair loss is common in patients with HIV-1 infection, and in black patients this loss may be associated with straightening. Possible causes are frequently present in patients with HIV-1. These causes include chronic HIV-1 infection itself and recurrent secondary infections, nutritional deficiencies, immunologic and endocrine dysregulation, and exposure to multiple drugs. However, histopathologic features have rarely been reported in these patients. OBJECTIVE The objective was to evaluate the changes in the hairs of a group of these patients and to identify the light microscopic and ultrastructural changes in the hairs and the histologic changes in the scalp. METHODS Hair plucks and pulls with scanning electron microscopy of the hairs were done on 10 patients with late-stage HIV-1 infection. In addition, scalp biopsy specimens were examined in both vertical and transverse sections. RESULTS All patients had telogen effluvium. Numerous apoptotic or necrotic keratinocytes were seen in the upper external root sheath follicular epithelium in addition to a mild to moderate perifollicular mononuclear cell infiltrate often containing eosinophils. Variable dystrophy of the hair shafts was also a consistent feature. CONCLUSION Although telogen effluvium is a common response to a wide spectrum of biologic stresses, the presence of apoptotic or necrotic keratinocytes within the upper end of the external root sheath epithelium and dystrophy of hairs may be markers of hair loss in patients with HIV-1 infection.

Papular eruption of human immunodeficiency virus disease : a review of the clinical, histologic and immunohistochemical findings in 48 cases

The papular eruption (PE) associated with human immunodeficiency virus infection, although described as a distinctive clinicopathologic entity, has shown a wide range of histologic findings ranging from eosinophilic folliculitis to granuloma annulare. We examined 48 cases of the PE in order to define the histologic spectrum of these lesions, and to correlate these findings with clinical presentations. The most distinctive clinical features are the frequency of these lesions in this population, the large number of lesions, pruritus, and the chronic nature of the lesions. His tologically, the distinctive features are the prominent perivascular factor XIIIa-positive dermal dendritic cells, atypigal vascular proliferation, and dermal fibrosis sometimes associated with diffuse necrobiotic changes.

Bacillus piliformis infection (Tyzzer's disease) in a patient infected with HIV-1 : Confirmation with 16S ribosomal RNA sequence analysis

Bacillus piliformis is a long, rod-shaped bacterium that has never been grown in cell-free medium and whose taxonomic classification is uncertain. B. piliformis is the causative agent of Tyzzers disease, which is frequently reported in laboratory, wild, and domesticated animals. The spectrum and severity of this disease is wide in animals. Although many infections are rapidly fatal, subclinical infections are also common. To date, there have been no reports of B. piliformis infection in human beings, although elevated antibody levels have been reported in pregnant women. We describe the first case of human B. piliformis infection, in a man with HIV-1 infection and chronic, localized, crusted verrucous lesions. The diagnosis was confirmed by ribosomal RNA sequencing. The spectrum of organisms leading to infection and the spectrum of diseases caused by these organisms continue to expand, as new infections are identified and as patients with HIV-1 live longer with more severe immune suppression. The extreme difficulty in culturing B. piliformis and the lack of clinical and histopathologic experience with this organism in human beings mean that B. piliformis is potentially another infectious agent to be considered in human beings. Also, when an infectious organism is a strong clinical consideration, silver stains may be of use when results of routine bacterial staining are negative.

Microsporidial Myositis and The Acquired Immunodeficiency Syndrome (AIDS): A Four-Year Follow-Up

Excerpt To The Editor:In 1985, Ledford and colleagues (1) reported the first case of a patient with the acquired immunodeficiency syndrome (AIDS) with myositis secondary to a microsporidial infecti...

Bacillary angiomatosis in an immunocompetent child

Bacillary angiomatosis (BA) is a pathological process characterized by prominent vascular proliferation secondary to organisms of the genus Rochalimaea. BA has been most commonly associated with HIV-1+ patients, but has also been reported rarely in other immune-suppressed patients and in a small group of patients with no demonstrated immune suppression. Even in immune-suppressed children, BA is extremely rare. We report a 5-year-old girl with no apparent immune suppression and no risk factors for HIV-1+ disease, who presented with a skin lesion that histopathologically was diagnostic of BA.

Melanocytic activation in HIV-1 disease: HMB-45 staining in common acquired nevi

BACKGROUND An increase in pigmented lesions has been reported in HIV-1-infected patients. In a study of HIV-1-positive patients, we have seen patients who noticed new or changing pigmented lesions. OBJECTIVE The goal of this study was to determine to what degree these pigmented lesions showed evidence of significant melanocytic proliferation as opposed to increased pigment production without significant melanocytic proliferation. METHODS Biopsy specimens were studied with routine light microscopy and immunohistochemical stains including S-100 protein, HMB-45, and proliferating cell nuclear antigen. RESULTS The lesions included two malignant melanomas and 42 benign melanocytic lesions. Significant staining of dermal melanocytes with HMB-45 was present in two of three melanomas and in 19 of 42 nevi. With stains for proliferating cell nuclear antigen there was a positive reaction in the dermal component of both melanomas and a negative reaction in the dermal cells of the nevi. CONCLUSION In some HIV-1-infected patients there is stimulation of melanosome production without significant melanocyte proliferation.