Clino-Pathological Correlation of Dermatological Manifestations in People Living with HIV/AIDS (PLHIV) at a Tertiary Care Hospital, Western India
Keywords:
Biopsy, Clinicopathological correlation, Histopathology, Infectious lesions, Skin lesions
Abstract
Background: A large number of skin conditions that might present to a dermatologist ranging from infectious to benign to malignant in HIV positive patients. Many of them need detailed and time consuming investigations to confirm the clinical diagnosis. Probably skin biopsy is the most important ancillary aid to confirm the clinical diagnosis. Skin biopsies play a vital diagnostic role when different diseases present with clinically similar skin lesions. A diagnostic approach is given based on the predominant histological reaction pattern, with an emphasis on clinicopathological correlation. So, this study tries to assess the clinic-pathological correlation in dermatological manifestations in PLHIV. Methods: Punch biopsies from the skin lesions were studied from March 2016 to April 2017 with routine histopathology examination and special stains were used as and when required. Clinical diagnosis was then correlated with histopathological examination. Result: A total of 60 punch biopsies of PLHIV were studied. 22 (36.66%) patients had infectious lesions and 38 (63.33%) patients had non-infectious lesions. Correlation of Clinical diagnosis was done with histopathological findings, which showed 88.8% of papular lesions well correlated histopathologically. Only 33% of malignant and premalignant skin conditions were diagnosed correctly on clinical examination. Overall, 68.33% of cases including non-neoplastic and neoplastic lesions, showed clinic-pathological consistency. Conclusion: Skin biopsy and clinicopathological correlation is clearly a worthwhile investigative procedure.References
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11. Goldstein B, Berman B, Sukeni kE, Frankel SJ. Correlation of skin disorders with CD4 lymphocyte counts in patients with HIV/AIDS. J Am Acad Dermatol.1997;36:262–4.
12. Smith KJ, Skelton HG, Yeager J. Cutaneous findings in HIV-1 positive patients: A 42-month prospective study. J Am Acad Dermatol.1994;31:746–54.
13. Coopman SA, Johnson RA, Platt R, Stern RS. Cutaneous disease and drug reactions in HIV infection. N Engl J Med.1993;328:1670–4.
14. Goodman DS, Teplitz ED, Wishner A. Prevalence of Cutaneous disease in patients with AIDS or AIDS-related complex. J Am Acad Dermatol.1987;17:210–20.
15. Coldiron BM, Bergstresser PR. Prevalence and clinical spectrum of skin disease in Patients infected with HIV. Arch Dermatol.1989;125:357–61.
16. Chawhan SM , Bhat DM, Solanke SM. Dermatological manifestations in human immunodeficiency virus infected patients: Morphological spectrum with CD4 correlation. Indian J Sex Transm Dis.2013 Jul-Dec;34(2):89–94.
17. Jindal N, Aggarawal A. HIV seropositive and HIV associated dermatosis among patients presenting with skin and mucocutaneous disorders. Indian journal of dermatology, venerology andleprology. 2009;75:283-286.
18. Singh H, Singh P, Tiwari P, Dey V, Dulhani N, Singh A, et al. Dermatological manifestations in hiv-infected patients at a tertiary care hospital in a tribal (bastar) region of chhattisgarh, india. Indian J Dermatol.2009Oct-Dec;54(4):338–341
19. Lanjewar DN. The spectrum of clinical and pathological manifestations of AIDS in a consecutive series of 236 autopsied cases in mumbai, India. Patholog Res Int 2011. 2011 547618.
20. Rajput JS, Singh K, Singh S, Singh A. Clinico-pathological study of non-neoplastic skin disorders. MedPulse–International Medical Journal August 2014;1(8):367-372.
21. Grayson W. The HIV positive skin biopsy. J Clin Pathol 2008;61:802–817.
2. Ranganathan K, Umadevi M, Saraswathi TR, Kumarasamy N, Solomon S, Johnson N, et al. Oral lesions and conditions associated with Human Immu-nodeficiency Virus infection in 1000 South Indian patients. Ann Acad Med Singapore.2004;33:37–42.
3. Moniaci D, Greco D, Flecchia G, Raitieri R, Sinicco A. Epidemiology, clinical features and prognostic value of HIV-1 related oral lesions. J Oral Pathol Med.1990;19:477–81.
4. NACO (2015) ‘Annual report 2015-16’.
5. Cedeno-Laurent F, Gomez-Flores M, Mendez N, Ancer-Rodriguez J, Bryant JL, Gaspari AA, et al. New insights into HIV-1-primary skin disorders. J int AIDS soc.,2011jan24.14:5.
6. Wiwanitkit V. Prevalence of dermatological disorders in Thai HIV-infected patients correlated with different CD4 lymphocyte count statuses: A note on 120 cases. Int J Dermatol.2004;43:265–8.
7. Kumarasamy N, Solomon S, Madhivanan P, Ravikumar B, Thyagarajan SP, Yesudian P, et al. Dermatologic manifestations among human immunodeficiency virus patients in south India. Int J Dermatol.2000;39:192–5.
8. Coopman SA, Johnson RA, Platt R, Stern R. Cutaneous disease and drug reactions in HIV Infection. N Engl J Med.1993;328:1670–4.
9. Tschachler E, Bergstresser PR, Sting lG. HIV-related skin diseases. Lancet.1996;348:659–63.
10. Uthayakumar S, Nandwani R, Drinkwater T, Nayagam AT, Darley CR. The prevalence of skin disease in HIV infection and its relationship to the degree of immunosuppression. Br J Dermatol.1997;137:595–8.
11. Goldstein B, Berman B, Sukeni kE, Frankel SJ. Correlation of skin disorders with CD4 lymphocyte counts in patients with HIV/AIDS. J Am Acad Dermatol.1997;36:262–4.
12. Smith KJ, Skelton HG, Yeager J. Cutaneous findings in HIV-1 positive patients: A 42-month prospective study. J Am Acad Dermatol.1994;31:746–54.
13. Coopman SA, Johnson RA, Platt R, Stern RS. Cutaneous disease and drug reactions in HIV infection. N Engl J Med.1993;328:1670–4.
14. Goodman DS, Teplitz ED, Wishner A. Prevalence of Cutaneous disease in patients with AIDS or AIDS-related complex. J Am Acad Dermatol.1987;17:210–20.
15. Coldiron BM, Bergstresser PR. Prevalence and clinical spectrum of skin disease in Patients infected with HIV. Arch Dermatol.1989;125:357–61.
16. Chawhan SM , Bhat DM, Solanke SM. Dermatological manifestations in human immunodeficiency virus infected patients: Morphological spectrum with CD4 correlation. Indian J Sex Transm Dis.2013 Jul-Dec;34(2):89–94.
17. Jindal N, Aggarawal A. HIV seropositive and HIV associated dermatosis among patients presenting with skin and mucocutaneous disorders. Indian journal of dermatology, venerology andleprology. 2009;75:283-286.
18. Singh H, Singh P, Tiwari P, Dey V, Dulhani N, Singh A, et al. Dermatological manifestations in hiv-infected patients at a tertiary care hospital in a tribal (bastar) region of chhattisgarh, india. Indian J Dermatol.2009Oct-Dec;54(4):338–341
19. Lanjewar DN. The spectrum of clinical and pathological manifestations of AIDS in a consecutive series of 236 autopsied cases in mumbai, India. Patholog Res Int 2011. 2011 547618.
20. Rajput JS, Singh K, Singh S, Singh A. Clinico-pathological study of non-neoplastic skin disorders. MedPulse–International Medical Journal August 2014;1(8):367-372.
21. Grayson W. The HIV positive skin biopsy. J Clin Pathol 2008;61:802–817.
Published
2018-05-21
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