Bonomo R A, Korman N, Nagashima-Whalen L, Briggs J, Graham R, Salata R A
Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Am J Med Sci. 1997 Aug;314(2):118-21. doi: 10.1097/00000441-199708000-00014.
Pityriasis rubra pilaris is an uncommon hyperkeratotic, papulosquamous disorder that has been reported in patients infected by HIV. We recount a case of pityriasis rubra pilaris in an HIV-seropositive man. A 36-year-old man with a history of ulcerative colitis and recurrent otitis externa had diffuse psoriaform erythroderma. He was treated initially with methotrexate and isoretinoin without clinical improvement. Skin examination showed large, erythematous, orange, scaly patches on the upper extremities and thickening of the nail beds. The palms and soles were hyperkeratotic. Skin biopsy revealed changes that were consistent with pityriasis rubra pilaris. Six months before the onset of symptoms, results of an enzyme-linked immunosorbent assay (ELISA) and Western Blot assay for HIV were negative. Six months after symptoms, results of repeat enzyme-linked immunosorbent assay and Western blots for HIV were positive (CD4+ T-cell count = 200 cells/ mm3). Clinical course had been complicated by episodes of Staphylococcus aureus bacteremia, mucocutaneous candidiasis, and development of localized squamous cell carcinoma of the skin. The increased severity of pityriasis rubra pilaris should prompt clinicians to consider coinfection with HIV in patients who have disease that is refractory to treatment. Clinicians also should remain vigilant for the development of squamous cell carcinoma.
红皮病型毛发红糠疹是一种罕见的角化过度性丘疹鳞屑性疾病，在HIV感染患者中已有报道。我们讲述一例HIV血清阳性男性的红皮病型毛发红糠疹病例。一名有溃疡性结肠炎和复发性外耳道炎病史的36岁男性患有弥漫性银屑病样红皮病。他最初接受甲氨蝶呤和异维A酸治疗，但临床症状无改善。皮肤检查显示上肢有大片红斑、橙色鳞屑斑，甲床增厚。手掌和足底角化过度。皮肤活检显示的变化与红皮病型毛发红糠疹一致。症状出现前6个月，HIV酶联免疫吸附试验（ELISA）和Western印迹法检测结果均为阴性。症状出现6个月后，重复进行的HIV酶联免疫吸附试验和Western印迹法检测结果为阳性（CD4 + T细胞计数 = 200个细胞/mm³）。临床病程因金黄色葡萄球菌菌血症、皮肤黏膜念珠菌病发作以及皮肤局部鳞状细胞癌的发生而复杂化。对于治疗难治性疾病的患者，红皮病型毛发红糠疹病情加重应促使临床医生考虑合并HIV感染。临床医生还应警惕鳞状细胞癌的发生。
