Cutaneous

Manifestations of HIV
By :
Ridwan Fajiri 110.207.019
Fitriani Syamsul 110.207.066
PATIENT IDENTITY
Name : Mr. A
Gender : Male
Age : 29 years old
Marital status : Single
Religion : Muslim
Occupation : Electrical Shop employee
Address : Adipura 2 B2/18
Addmission date : 06/09/2012
HISTORY TAKING
Chief Complaint: watery stool
Brief anemnesis: since a day ago, frec. 10/day.
mucous (-), blood (-). History watery stool (+) since 2
years back. Febris since a day ago, intermittent, and
decrease with medicine. Swering (-), Headache (-
),cough (+) since 1 week, mocous (-), chest pain (-),
nause (+), vomitting (+) frec. 3 x a day. loss of
appetite since 1 year ago with decrease of body
weight.

Medical history : TB treatment (+) since 1 year
IV drug consumption (-)
Alkohol comsumption (-)
CURRENT STATUS
Consciousness : Compos Mentis
General Condition : Moderate
Hygiene : Moderate
Nutrition : Less
Vital sign
BP : 100/60 mmHg
Pulse : 80x/minutes
RR : 20/minutes
Temperature : 37,5
0
C


PHYSICAL EXAMINATION
Anemic (-), icterus (-), cyanoses (-)
Cor/ Pulmonal: Normal
Abdomen: Normal, peristaltic (+)
Extremities: Edema (-)
Lymph nodes: Enlargement (-)
DERMATO-VENEROLOGY
STATUS
Region: Facialis
Efloresensi:
Hyperpigmentation all of face
Squama in eyeshadow, around the
mouth, beard, and ears
oRegion : Auricular dextra
oEfloresensi : Squama
REGION FACIALIS
REGION AURICULAR DEXTRA
LABORATORY RESULT
Ureum : 4 mg/dl (N= 10 - 50 mg/dL)
Creatine : 0,92 mg/dl
SGOT : 219 U/I
SGPT : 77 U/I
WBC : 1.6 x 10
3
/uL
RBC : 2,92 x 10
6
/uL
HB : 7,4 (g/dL)
HCT : 22,2 %
PLT : 63x10
3
/uL


RAPID TEST HIV
Reagen 1 (SD) : reaktif
Reagen 2 (oncoprole) : reaktif
Reagen 3 (advance) : reaktif
Kesimpulan Reaktif
RESUME
Mr.A 29 years old, came to hospital with atery stool since a
day ago, frec. 10/day. History watery stool (+) since 2
years back. Febris since a day ago, intermittent, and
decrease with medicine. cough (+) since 1 week, nause
(+), vomitting (+) frec. 3 x a day. loss of appetite since 1
year ago with decrease of body weight. Medical history : TB
treatment (+) since 1 year.



Region: Facialis
Efloresensi:
Hyperpigmentation all of face
Squama in eyeshadow, around the mouth, beard,
and ears
o Region : Auricular dextra
o Efloresensi : Squama


DIAGNOSTIC
DISCUSSION
Cutaneous manifestations of human
immunodeficiency virus (HIV) disease may
result from HIV infection. Cutaneous disorders
may be the initial signs of HIV-related
immunosuppression. Recognizing HIV-related
skin changes may lead to the diagnosis of HIV
infection in the early stages, allowing initiation of
appropriate antiretroviral therapy.


Generalized dry skin syndrome is frequently
observed in patients with HIV infection. Xerosis
may be the initial clinical manifestation of AIDS
and is often a cause of pruritus. In the United
States, pruritus has been reported in 4.5% of
patients with AIDS.


PAPULOSQUAMOUS DERMATOSES OF AIDS
CONT...
Seborrheic dermatitis may be the initial cutaneous
manifestation of HIV disease. According to Mathes et
al, seborrheic dermatitislike eruptions are observed in
83% of patients with AIDS.
[26]
The eruption, which is
characterized by widespread inflammatory and
hyperkeratotic lesions, may progress to erythroderma
in some patients. Seborrheic dermatitis may be
increased in patients with AIDS-associated dementia
or CNS disease

PHOTOSENSITIVITY AND DRUG-INDUCED PIGMENTATION
A study by Vin-Christian et al found that
photosensitivity in HIV-infected patients appears to be
a manifestation of advanced disease.

Most of the
patients in that study were sensitive to ultraviolet B
(UV-B) light; however, the patients who were most
severely affected were sensitive to both UV-B and
UV-A light.

Photo-induced lichenoid drug reactions may occur
in HIV-infected patients, particularly those with
dark skin. In addition, HIV-infected patients may
experience drug-induced pigmentation of skin
exposed to light.

CONT...
EXAMINATION
1. Wood lamp
2. Mycologic examination :
10-15% KOH preparation
From Skin scraping
Fungal culture on Saborauds agar media


THERAPY
Systemic therapy :
IVFD RL 28 tpm
Pantoprazole 40 mg a day iv
Ceftriaxone 1 gr a day iv

Topical Therapy :
Vaselin 50 gr
Lanolin 20 gr

DIFFERENTIAL DIAGNOSIS
Tinea Versikolor
Melasma

TINEA VERSIKOLOR
Tinea versicolor is a common,
benign, superficial cutaneous fungal
infection usually characterized by
hypopigmented or hyperpigmented
macules and patches on the chest
and the back. In patients with a
predisposition, tinea versicolor may
chronically recur. The fungal infection
is localized to the stratum corneum.
MELASMA
Melasma is an acquired
hypermelanosis of sun-exposed areas.
Melasma presents as symmetric
hyperpigmented macules, which can be
confluent or punctate. The cheeks, the
upper lip, the chin, and the forehead
are the most common locations, as
shown in the images below, but
melasma can occasionally occur in
other sun-exposed locations. Note the
images below.
PROGNOSTIC
10 years after HIV infection 50% of patients
had AIDS. Prognosis is poor AIDS because
HIV infects mainly CD4 + T cells of the
immune system and will lead to the
destruction of these cells, resulting in many
illnesses that will accompany it.
WASSALAM