Disseminated cutaneous lesions in an HIV‐positive patient—Is there more than meets the eye?

Abstract

A patient living with HIV developed disseminated erythematous plaques and the biopsy was consistent with hematological neoplasm infiltration. Further evaluation revealed hepatosplenomegaly, anemia, thrombocytopenia, and leukocytosis, with 33% myeloblasts. Bone marrow assessment confirmed acute myelomonocytic leukemia, with NPM1 mutation. The patient was treated with a conventional induction regimen obtaining complete remission.

Although HIV patients often develop skin lesions related to their disease, its treatments, and even opportunistic infections, atypical cutaneous lesions should prompt a broad differential diagnosis investigation, including hematological disorders.

1. CLINICAL CASE

A 40‐year‐old woman with a history of HIV infection under antiretroviral therapy, CD4 counts within the reference value, and undetectable viral load, presented at the outpatient clinic with non‐pruriginous disseminated erythematous plaques, sparing palms, and soles developing over 1‐month evolution (Figure 1).

FIGURE 1.

Skin infiltration and gingival hypertrophy in a myelomonocytic leukemia patient.

The biopsy of these lesions was consistent with blastic plasmacytoid dendritic cell neoplasm vs. acute myeloid leukemia.

Pending the results of the biopsy, the patient suffered clinical deterioration and was urgently referred to the hematology department. Physical examination and laboratory analysis revealed gingival hypertrophy, hepatosplenomegaly, anemia, thrombocytopenia, and leukocytosis of 97.7 × 109/L with 33% myeloid blasts.

Bone marrow assessment confirmed acute myelomonocytic leukemia, with normal karyotype, presence of NPM1 mutation, and unmutated FLT3.

The patient was treated with a conventional induction regimen obtaining clinical, morphological, and molecular remission.

HIV patients are at greater risk for developing acute myeloid leukemia due to unclear, possibly immune‐related mechanisms.

AUTHOR CONTRIBUTIONS

Daniela Sofia Neves Sousa Maia: Conceptualization; writing – original draft; writing – review and editing. Fernanda Braga Seganfredo: Conceptualization; writing – original draft; writing – review and editing. Albertina Figueiredo Nunes: Conceptualization; writing – review and editing.

FUNDING INFORMATION

None.

CONFLICT OF INTEREST

The authors have no conflict of interest to declare.

CONSENT

Written informed consent was obtained from the patient to publish this report in accordance with the journal's patient consent policy.

de Sousa Maia DSN, Seganfredo FB, Nunes AF. Disseminated cutaneous lesions in an HIV‐positive patient—Is there more than meets the eye? Clin Case Rep. 2022;10:e06669. doi: 10.1002/ccr3.6669

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.