Requena L, Sánchez Yus E, Martín L, Barat A, Arias D
Department of Dermatology, Jiménez Díaz Foundation, Nuestra Señora de la Concepción Clinic, Universidad Autónoma, Madrid, Spain.
Arch Dermatol. 1991 Dec;127(12):1819-22.
Several types of vasculitis have been described in patients with human immunodeficiency virus infection. Erythema elevatum diutinum is a rare variant of cutaneous leukocytoclastic vasculitis which, with the exception of the case reported herein, has been described only once in human immunodeficiency virus-infected patients. Our male patient, a longtime intravenous drug abuser, had cutaneous lesions, closely resembling Kaposi's sarcoma, on the extensor surfaces of the lower extremities. Cutaneous biopsy specimens, however, demonstrated leukocytoclastic vasculitis with fibrinoid necrosis of the vessel walls and areas of basophilic degeneration of collagen bundles in early lesions, whereas late lesions showed dense diffuse fibrosis with proliferation of dermal spindle cells and some foci of residual leukocytoclastic vasculitis. Oral therapy with dapsone resulted in marked clearing of the cutaneous lesions within few days. This case raises the necessity of histologic confirmation for all cases of suspected Kaposi's sarcoma in patients with acquired immunodeficiency syndrome. We discuss the possible pathogenesis of leukocytoclastic vasculitis in human immunodeficiency virus-infected patients.
在人类免疫缺陷病毒感染患者中已描述了几种类型的血管炎。持久性隆起性红斑是皮肤白细胞破碎性血管炎的一种罕见变异型，除本文报道的病例外，仅在人类免疫缺陷病毒感染患者中被描述过一次。我们的男性患者是一名长期静脉注射吸毒者，在下肢伸侧有酷似卡波西肉瘤的皮肤损害。然而，皮肤活检标本显示，早期损害为白细胞破碎性血管炎，伴有血管壁纤维蛋白样坏死及胶原束嗜碱性变性区域，而晚期损害则表现为致密的弥漫性纤维化，伴有真皮梭形细胞增生及一些残留的白细胞破碎性血管炎灶。口服氨苯砜治疗在数天内使皮肤损害明显消退。该病例提示，对于获得性免疫缺陷综合征患者中所有疑似卡波西肉瘤的病例均有必要进行组织学确诊。我们讨论了人类免疫缺陷病毒感染患者白细胞破碎性血管炎的可能发病机制。
