S. Muratori

Erythema elevatum diutinum and HIV infection : a report of five cases

Erythema elevatum diutinum (EED) is emerging as a specific HIV‐associated dermatosis, 11 cases having so far been reported in the medical literature and five patients with the disease having been seen by us during the last 4 years. As the disease is poorly known, it is easily confused with Kaposis sarcoma or bacillary angiomatosis, but the histopathological features are diagnostic. EED is considered to be an immune complex‐mediated vasculitis. A streptococcal infection seemed to be the trigger factor in four of our patients. Partial control of the cutaneous lesions was achieved by the use of antibiotics.

Cognitive abnormalities and disease progression in a selected population of asymptomatic HIV-positive subjects.

A selected population of 41 homosexual/bisexual asymptomatic HIV-positive subjects were administered neurophysiological tests to assess language, memory, attention, logic faculties and visuo-motor functions. HIV-positive subjects differed from individually matched control subjects only in certain measures of verbal memory. Longitudinal evaluation performed after 1.5 years, however, did not indicate any further development of this mild amnesic deficit. Despite the small number studied in our sample, there seems to be a trend for older subjects to be at greater risk of developing AIDS and cognitive abnormalities than younger subjects, while differences in immunological status play a significant role in disease progression.

Cutaneous lupus erythematosus induced by adalimumab

Figure 2. Atrophic epidermis with vacuolar changes of the basal layer and dermal perivascular lymphocytic infiltration. Dear Editor, Tumor necrosis factor-a (TNF-a) antagonists are approved for treating rheumatoid arthritis and are commonly used in patients previously unresponsive to treatment with traditional disease-modifying antirheumatic drugs (DMARDs). Adalimumab is the only fully human anti-TNF-a monoclonal antibody considered to be a treatment option for rheumatoid arthritis. One of the most common side-effects is the development of autoantibodies, such as antinuclear (ANA), anti-double-stranded DNA (dsDNA) and antinucleosome; however, rare cases of drug-induced lupus erythematosus (LE) upon adalimumab therapy are reported, especially in its cutaneous variants. We report a 61-year-old woman affected by rheumatoid arthritis associated with negative rheumatoid factor and positive antibodies to cyclic citrullinated peptide; screening ANA, anti-dsDNA and antiextractable nuclear antigen antibodies (ENA) panels were normal and she had no prior history of cutaneous lesions. The patient’s arthritis had initially been controlled for 2 years by non-steroidal anti-inflammatory drugs and methotrexate (10 mg ⁄weekly), but this agent induced an increasing of transaminase; then, adalimumab was started at a dose of 40 mg s.c. every 2 weeks. Three months later, laboratory evaluation revealed an ANA titer of 1:160 with homogeneous pattern. After 2 years of anti-TNF-a therapy, adalimumab was discontinued for 3 months; when it was restarted, at the second administration, the patient developed well-demarcated, erythematous, sometimes scaly confluent plaques predominantly localized on the upper area of the trunk and on the face associated with a moderate itching (Fig. 1). She had no another systemic symptoms. ANA were positive at titer of 1:640 with homogeneous pattern, while dsDNA, ENA, full blood count, complement components C3 and C4, immunoglobulins, erythrocyte

Three-year neuropsychological follow-up in a selected group of HIV-infected homosexual/bisexual men

ObjectiveTo evaluate changes in cognition in a selected group of asymptomatic homosexual/bisexual men over a 3-year period. Patients and methodsSixty HIV-infected (Centers for Disease Control stage II) subjects and 60 controls (individually matched for age and years in education) were administered neuropsychological tests evaluating attention, language, memory, logic and visuo-motor abilities. None of the patients had a history of alcohol or drug abuse, and all received the baseline cognitive evaluation within 18–24 months of seroconversion. ResultsThe HIV-infected subjects differed from controls in only one of the six memory tests (P< 0.01). Follow-up evaluation after 18 and 36 months (available for 51 and 36 subjects, respectively) demonstrated a significant deterioration in visuo-motor ability (P< 0.01) only in subjects who had progressed to AIDS, without signs or symptoms of central nervous system involvement. ConclusionsThe data suggest that cognitive alterations in asymptomatic stages of HIV infection are in most subjects minor and do not develop. Percentage rates of CD4 lymphocyte decline appear to be significantly related to deterioration in visuo-motor abilities.

Lichen myxoedematosus in a patient with AIDS

We report a patient with acquired immunodeficiency syndrome (AIDS) who developed a widespread popular eruption due to deposition of muein in the dermis. Paraproteinaemia was demonstrated. Lichen myxoedematosus type 2 was diagnosed. This is the third case of this rare disorder reported in a human immunodeficiency virus (HIV)‐seropositive subject.

Bullous pemphigoid and dermatitis herpetiformis association: A genetic predisposition

1 Reed BR, Huff JC, Jones SK et al. Subacute cutaneous lupus erythematosus associated with hydrochlorothiazide therapy. Ann Intern Med Jul 1985; 103(1): 49–51. 2 Lowe G, Henderson CL, Grau RH et al. A systematic review of druginduced subacute cutaneous lupus erythematosus. Br J Dermatol 2011 Mar; 164(3): 465–472. 3 Naranjo CA, Busto U, Sellers EM et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30: 239–245. 4 Kindem S, Llombart B, Requena C et al. Subacute cutaneous lupus erythematosus after treatment with capecitabine. J Dermatol 2013 Jan; 40(1): 75–76.