Papulonecrotic tuberculid in an HIV-positive patient

2007 ◽  
Vol 18 (9) ◽  
pp. 643-644 ◽  
Author(s):  
Victoria Akhras ◽  
Gill McCarthy
Keyword(s):  
Skin Biopsy ◽  
Immunological Response ◽  
Hiv Positive ◽  
Papular Eruption ◽  
The Face ◽  
Night Sweats ◽  
Focus Of Infection ◽  
History Of ◽  
Haematogenous Spread ◽  
Systemic Symptoms

We present a 33-year-old HIV-positive man who presented with a two-year history of a non-itchy papular eruption, associated with night sweats, headaches, poor memory and weight loss. On examination, he had erythematous papular lesions with necrotic centres on the face, arms and torso with no systemic abnormalities. A skin biopsy eventually led to the diagnosis of papulonecrotic tuberculid, and treatment with quadruple therapy resulted in resolution of his rash and systemic symptoms. Papulonecrotic tuberculid is thought to be a immunological response to Mycobacterium bacillus components in a previously sensitized patient following haematogenous spread from a focus of infection elsewhere. Cultures from the skin are typically negative and there are no acid-fast bacilli seen, but mycobacterial DNA can be detected using polymerase chain reaction. This case is an example of the paradoxical activation of the immune system seen in patients with HIV. It highlights the importance of skin biopsy in patients with unexplained systemic symptoms and a rash, as the differential diagnosis can be wide in HIV.

scholarly journals LUPUS VULGARIS DENGAN LESI DISEMINATA

2015 ◽  
Vol 7 (3) ◽  
Author(s):  
Nana N. Jayadi ◽  
Niken Ernaningtyas ◽  
Nurdjannah J. Niode ◽  
Marthen C. P. Wongkar
Keyword(s):  
Wound Care ◽  
Giant Cells ◽  
Lupus Vulgaris ◽  
Open Wound ◽  
Cutaneous Tuberculosis ◽  
Left Neck ◽  
The Face ◽  
Night Sweats ◽  
History Of ◽  
Erythematous Plaques

Abstract: Lupus vulgaris (LV) is a chronic progressive form of paucibacillary cutaneous tuberculosis. Lesion is usually solitary in the form of nodes or erythematous plaques with an apple-jelly sign on diascopy. Disseminated LV is a rare form of cutanoeus tuberculosis with multiple lesions in several body areas. We reported a male of 40 years old with a suppurative wound on the left neck and reddish nodules on the face, neck, trunk, and limbs along with fever, night sweats, weight loss, and history of previous TB infections. There were multiple erythematous nodules and painful suppurating ulcers with enlargement of several lymph nodes. Apple-jelly sign appeared on diascopy. The FNAB showed specific granulamatous inflammation for TB with lymphocytes, epitheloid macrophages, and multinucleated giant cells. The histopathological finding showed tubercles surrounded by macrophages and lymphocytes. Anti-tuberculosis drugs category I were given for 6 months, ofloxacin, and open wound care compressed with NaCl 0.9%. In the third month of observation, there was significant improvement. Conclusion: This case was diagnosed as lupus vulgaris based on the history of lymphadenitis TB and scrofuloderma, lesions in several body area with positive diascopy test, the FNAB as well as the histopathologic result supporting the diagnosis of tuberculosis, and there was significant improvement after treatment with antiTB drugs.Keywords: lupus vulgaris, diseminata, tuberculosis, ofloksasinAbstrak: Lupus vulgaris (LV) merupakan tuberkulosis (TB) kutis pausibasiler kronis dan progresif. Lesi biasanya soliter, berupa nodus atau plak eritematosa dengan gambaran apple-jelly pada diaskopi. Lupus vulgaris diseminata merupakan bentuk TB kutis yang jarang ditemukan dengan lesi multipel pada beberapa area tubuh secara bersamaan. Kami melaporkan seorang laki-laki, 40 tahun, dengan luka bernanah pada leher kiri dan benjolan-benjolan kemerahan pada wajah, leher, badan, dan tungkai disertai demam, keringat malam, penurunan berat badan dan riwayat infeksi tuberkulosis sebelumnya. Pada pemeriksaan fisik tampak nodus eritematosa multipel disertai ulkus bernanah dan pembesaran beberapa kelenjar getah bening. Gambaran apple-jelly tampak pada diaskopi. Pemeriksaan FNAB menunjukkan gambaran radang granulomatik spesifik TB dengan adanya sel-sel radang limfosit, kelompok makrofag epiteloid, dan sel-sel datia Langhans. Pemeriksaan histopatologis memberikan gambaran tuberkel yang dikelilingi oleh makrofag dan limfosit. Terapi diberikan berupa OAT kategori I selama 6 bulan, ofloksasin, dan kompres terbuka dengan NaCL 0,9%. Pada bulan ketiga tampak perbaikan signifikan. Simpulan: Pada kasus ini, diagnosis lupus vulgaris ditegakkan berdasarkan adanya riwayat limfadenitis TB dan skrofuloderma, lesi di beberapa area tubuh sekaligus dengan pemeriksaan diaskopi positif, gambaran FNAB dan histopatologis menunjang diagnosis TB, dan pengobatan dengan OAT memberikan perbaikan bermakna.Kata kunci: lupus vulgaris, diseminata, OAT, ofloksasin

scholarly journals Facial miliary osteoma in HIV patient

2011 ◽  
Vol 86 (4 suppl 1) ◽  
pp. 66-68
Author(s):  
Camila Camozzato ◽  
Franciani de Oliveira Basso ◽  
Rodrigo Pereira Duquia ◽  
Ana Letícia Boff ◽  
Hiram Larangeira de Almeida Jr
Keyword(s):  
Virus Infection ◽  
Bone Formation ◽  
Optical Microscopy ◽  
Female Patient ◽  
Computerized Tomography ◽  
Previous History ◽  
Hiv Positive ◽  
Hiv Virus ◽  
The Face ◽  
History Of

Facial miliary osteoma is characterized by the presence of multiple normochromic papules, affecting mainly middle-aged women, with a previous history of acne. A 39-year-old HIV positive female patient presented hardened papules which had appeared 3 years before, located on the malar region, glabella and mentum. Optical microscopy showed spherical bone formations in the dermis. Computerized tomography of the face revealed small calcifications on the surface consistent with bone formation. Multiple facial osteomas are rare as well as its association with HIV virus infection

scholarly journals Concurrent pulmonary tuberculosis and lepromatous leprosy in a newly diagnosed HIV positive patient: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Josiah T. Masuka ◽  
Zamambo Mkhize ◽  
Somasundram Pillay ◽  
Anisa Mosam
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lepromatous Leprosy ◽  
Positive Patient ◽  
Hiv Positive ◽  
Interdisciplinary Management ◽  
Immunodeficiency Virus ◽  
The Face ◽  
History Of ◽  
Tuberculosis Diagnosis ◽  
High Index Of Suspicion

Abstract Background The leprosy-tuberculosis (TB) co-infection is rarely reported in recent times. However, this dual comorbidity is associated with high mortality and major morbidity. Unrecognised leprosy-TB co-infection may predispose affected patients to rifampicin monotherapy and subsequent drug resistance. Case presentation A 35 year old migrant, human immunodeficiency virus (HIV) positive male worker presented with 6 month history of symmetric infiltrative nodular plaques of the face and distal, upper extremities. A few days after initial dermatology presentation, a sputum positive pulmonary tuberculosis diagnosis was made at his base hospital. Subsequent dermatology investigations revealed histology confirmed lepromatous leprosy and a weakly reactive rapid plasma reagin test. The presenting clinical features and laboratory results were suggestive of lepromatous leprosy coexisting with pulmonary tuberculosis in an HIV positive patient. Conclusions This case illustrates the occurrence of leprosy with pulmonary tuberculosis in an HIV infected patient and the difficulties in interpreting non-treponemal syphilis tests in these patients. This case also highlights the need for a high index of suspicion for co-infection and the need to exclude PTB prior to initiation of rifampicin containing multi-drug therapy (MDT). Interdisciplinary management and social support are crucial in these patients.

scholarly journals Bartonella henselaeInfection: An Uncommon Mimicker of Autoimmune Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Despoina N. Maritsi ◽  
Diagoras Zarganis ◽  
Zoi Metaxa ◽  
Georgia Papaioannou ◽  
George Vartzelis
Keyword(s):  
Clinical Laboratory ◽  
Imaging Features ◽  
Immunocompetent Host ◽  
X Ray ◽  
Systemic Involvement ◽  
Night Sweats ◽  
History Of ◽  
Chest X Ray ◽  
Systemic Symptoms ◽  
Immunocompetent Patients

We present a case of a seven-year-old immunocompetent female patient who developed systemic symptoms mimicking an autoimmune rather than an infectious disease. The patient presented with rash, biquotidian fever, night sweats, and arthralgias. There was no antecedent history of cat contact. Investigations showed increased inflammatory markers, leukocytosis, thrombocytosis, hypercalcemia, and raised angiotensin-converting enzyme. Interferon-gamma releasing assay for tuberculosis infection was negative. Abdominal imaging demonstrated multifocal lesions of the liver and spleen (later proved to be granulomata), chest X-ray showed enlarged hilar lymph nodes, and ophthalmology review revealed uveitis. Clinical, laboratory, and imaging features pointed towards sarcoidosis. Subsequently, raised titers (IgM 1 : 32, IgG 1 : 256) againstBartonellaconfirmed the diagnosis ofB. henselaeinfection. She was treated with gentamycin followed by ciprofloxacin; repeat investigations showed complete resolution of findings. The presence of hepatic and splenic lesions in children with bartonellosis is well documented. Our case, however, exhibited certain unusual findings such as the coexistence of acute ocular and systemic involvement in an immunocompetent host. Serological testing is an inexpensive and effective way to diagnose bartonellosis in immunocompetent patients; we suggest that bartonella serology is included in the baseline tests performed on children with prolonged fever even in the absence of contact with cats in countries where bartonellosis is prevalent.

scholarly journals A Case of Diffuse Cutaneous Leishmaniasis in a HIV Positive Patient

1970 ◽  
Vol 29 (2) ◽  
pp. 106-108
Author(s):  
I Patwary ◽  
M Rahman ◽  
M Ahmed ◽  
S Ahmedm ◽  
MSR Choudhury
Keyword(s):  
Weight Loss ◽  
Skin Biopsy ◽  
Plasma Cells ◽  
External Genitalia ◽  
Skin Lesions ◽  
Hiv Positive ◽  
Left Cheek ◽  
First Case ◽  
The Face ◽  
Trunk Skin

A cultivator of 30 years of age presented with fever, cough, diarrhoea, anorexia and weight loss for 6 months and papulonodular skin lesions for one month. Skin lesions appeared on the face, first over the left cheek and gradually involved whole of his face, extremities and external genitalia sparing the trunk. Skin biopsy from the nodule showed collection of histiocytes, lymphocytes & plasma cells with plenty of LD bodies inside the histiocytes. Screening test for HIV was positive and it was confirmed with western blot. Probably this is the first case Leishmaniasis/ HIV co infection reported from Bangladesh. DOI: http://dx.doi.org/10.3329/jbcps.v29i2.7957 (J Bangladesh Coll Phys Surg 2011; 29: 106-108)

Luxury Communist Jesus

2016 ◽  
Vol 7 (3) ◽  
pp. 245-255 ◽  
Author(s):  
Michael J. Sandford
Keyword(s):  
Work Ethic ◽  
Protestant Work Ethic ◽  
The Face ◽  
History Of ◽  
The Protestant Work Ethic

This article begins by outlining contemporary anti-work politics, which form the basis of Sandford’s reading. After providing a brief history of anti-work politics, Sandford examines recent scholarly treatments of Jesus’ relationship to work. An examination of a number of texts across the gospel traditions leads Sandford to argue that Jesus can be read as a ‘luxury communist’ whose behaviour flies in the face of the Protestant work ethic. Ultimately, Sandford foregrounds those texts in which Jesus discourages his followers from working, and undermines work as an ‘end in itself’, contextualising these statements in relation to other gospel texts about asceticism and the redistribution of wealth.

Antiretroviral Treatment-Associated Labia Majora Lipohypertrophy: A Rare Case and Plastic Surgical Treatment Options

2017 ◽  
Vol 2 (1) ◽  
pp. 43
Author(s):  
Akmal Hisham ◽  
Devananthan Ilenghoven ◽  
Wan Syazli Wan Ahmad Kamal ◽  
Salina Ibrahim ◽  
Shah Jumaat Mohd Yussof
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Daily Living ◽  
Treatment Options ◽  
Hiv Positive ◽  
Highly Active ◽  
Labia Majora ◽  
The Face ◽  
Central Fat

The emergence of highly active antiretroviral therapy (HAART) has revolutionized the prognosis of HIV-infected patients. However, the extended use of HAART is associated with a disfiguring complication termed lipodystrophy, a disorder of body fat maldistribution causing peripheral fat loss (lipoatrophy) and central fat accumulation (lipohypertrophy). Lipoatrophy commonly affects the face, legs, buttocks and arm, whilst lipohypertrophy frequently favours the abdomen, breast and dorsocervical region. To our knowledge, we present only the second documented case in the literature of a labia majora lipohypertrophy in a HIV-positive patient receiving long-term HAART. The severity of labial abnormality caused significant physical and functional morbidities. Labiaplasty with dermolipectomy of the labia majora and excisional lipectomy of the mons pubis was successfully performed. At a 6-month follow-up, patient had no recurrence with resolution of symptoms and resumption of normal activities of daily living (ADL).

Filthy Material

2018 ◽  
Author(s):  
Chris Forster
Keyword(s):  
Twentieth Century ◽  
New Media ◽  
Twentieth Century Literature ◽  
Modernist Literature ◽  
Literary Value ◽  
Radclyffe Hall ◽  
Media Technologies ◽  
The Face ◽  
History Of ◽  
The Media

Modernist literature is inextricable from the history of obscenity. The trials of such figures as James Joyce, D. H. Lawrence, and Radclyffe Hall loom large in accounts of twentieth-century literature. Filthy Material: Modernism and the Media of Obscenity reveals the ways that debates about obscenity and literature were shaped by changes in the history of media. The emergence of film, photography, and new printing technologies shaped how “literary value” was understood, altering how obscenity was defined and which texts were considered obscene. Filthy Material rereads the history of modernist obscenity to discover the role played by technological media in debates about obscenity. The shift from the intense censorship of the early twentieth century to the effective “end of obscenity” for literature at the middle of the century was not simply a product of cultural liberalization but also of a changing media ecology. Filthy Material brings together media theory and archival research to offer a fresh account of modernist obscenity with novel readings of works of modernist literature. It sheds new light on figures at the center of modernism’s obscenity trials (such as Joyce and Lawrence), demonstrates the relevance of the discourse of obscenity to understanding figures not typically associated with obscenity debates (such as T. S. Eliot and Wyndham Lewis), and introduces new figures to our account of modernism (such as Norah James and Jack Kahane). It reveals how modernist obscenity reflected a contest over the literary in the face of new media technologies.

Can an Adulteress Save Jesus? the Pericope Adulterae, Feminist Interpretation, and the Limits of Narrative Agency

2018 ◽  
Author(s):  
Jennifer Knust
Keyword(s):  
Point Of View ◽  
Feminist Interpretation ◽  
Narrative Agency ◽  
The Status ◽  
The Face ◽  
History Of

The pericope adulterae (John 7:53–8:11) is often interpreted as an inherently feminist story, one that validates women’s humanity in the face of a patriarchal order determined to reduce sexual sinners and women more generally to the status of object. Reading this story within a framework of queer narratology, however, leads to a different point of view, one that challenges the consequences of seeking rescue from a god and a text that are both quite willing to forge male homosocial bonds at a woman’s expense. As the history of this story also shows, texts and their meanings remain unsettled and therefore open to further unpredictable and contingent elaboration. Pondering my own feminist commitments, I attempt to imagine a world and a story where a woman is a person and Jesus is in need of rescue. Perhaps such a world is possible. Or perhaps it is not.

Married Life in the Middle Ages, 900-1300

2019 ◽  
Author(s):  
Elisabeth van Houts
Keyword(s):  
Middle Ages ◽  
Married Couple ◽  
Self Determination ◽  
Emotional Life ◽  
Social And Emotional ◽  
Individual Agency ◽  
Married Life ◽  
The Face ◽  
History Of ◽  
The Individual

This book contains an analysis of the experience of married life by men and women in Christian medieval Europe c. 900–1300. The focus will be on the social and emotional life of the married couple rather than on the institutional history of marriage. The book consists of three parts: the first part (Getting Married) is devoted to the process of getting married and wedding celebrations, the second part (Married Life) discusses the married life of lay couples and clergy, their sexuality, and any remarriage, while the third part (Alternative Living) explores concubinage and polygyny as well as the single life in contrast to monogamous sexual unions. Four main themes are central to the book. First, the tension between patriarchal family strategies and the individual family member’s freedom of choice to marry and, if so, to what partner; second, the role played by the married priesthood in their quest to have individual agency and self-determination accepted in their own lives in the face of the growing imposition of clerical celibacy; third, the role played by women in helping society accept some degree of gender equality and self-determination to marry and in shaping the norms for married life incorporating these principles; fourth, the role played by emotion in the establishment of marriage and in married life at a time when sexual and spiritual love feature prominently in medieval literature.

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