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)
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