The.Bird@f38.n135.z1.fidonet.org (The "Bird") (09/25/90)
CASE REPORTS: COMMENTS BT INVESTIGATIVE TEAM Patient #1: This 23 year-old man was diagnosed in October 1989 as HIV antibody positive, confirmrd by Western Blot. He presented with progressive constitutional symptoms and rapid appearance of pruritic (itchy), palpable, erythematous (redness of the skin produced by congestion of the capillaries) and crusty skin lesions. Skin and rectal biopsies were read by Dr. Alonso as consistent with KS. After hyperthermia treatment on February 20, 1990, this patient had a dramatic clinical improvement with rapid resolution of skin lesions and an enhanced sense of well being. Prior to hyperthermia treatment, however, the patient received interpheron alpha and a broad spectrum antibiotic, which confounds the ability to interpret reponse hyperthermia alone. The pathologic specimens upon which patient #1's diagnosis of KS was made by Dr. Alonso (biopsies of skin and rectum) were reviewed with Drs. Douglas Wear and Peter Angritt of the Registry of AIDS pathology at the Armed Forces Institute of Pathology in Washington, D.C. Their findings differ from those of Dr. Alonso's and show no evidence of KS. The skin biopsies show evidence for an inflammatory process and suggest dermal folliculitis of unknown etiology. The patient's history of cat scratches, his clinical presentation, and his unusually rapid reponse that was temporally related to the administration of antibiotics all suggest the possibility of disseminated bacillary epithehoid angiomatosis (BEA) secondary to infection with cat scratch bacillus as an etiology. This is one of several inflammatory conditions that could be considered. Without special staining of these specimens, it is impossible to infer possible causes of this clinical scenario. In addition, in April, the patient had a recrrance of similar skin lesions on his foot that reponded to a treatment regimen that included broad spectrum antibiotics. Data presented do not allow conclusions about either the immunologic or virologic effects of hyperthermia. This patient remains HIV positive and currently has mild immune suppression. (continued) -- Uucp: ...{gatech,ames,rutgers}!ncar!asuvax!stjhmc!135!38!The."Bird" Internet: The."Bird"@f38.n135.z1.fidonet.org