We report five cases of symptomatic primary HIV infection. Four of the cases were MSM (men who have sex with men). They presented with a high grade fever lasting at least 3 days, lymphadenopathy, and sore throat. Erythema without pruritus was found on their trunks and extremities. They also had whitish spots on the buccal mucosa mimicking Koplick’s buccal spot or petechia on the hard palates. Results of blood tests showed cytopenia and liver dysfunction. HIV screening tests of the fourth generation showed slightly positive reactions. Levels of HIV-1 RNA in serum were very high, indicating the presence of acute HIV infection, even though anti-HIV-1 antibodies were not detected by Western blotting assays. Although the effects of antiretroviral therapy on primary HIV infection are not established, early detection of HIV infection is important so that treatment can be started at an appropriate point. Well-timed treatment can improve quality of life by avoiding the progression into AIDS and can prevent the infection from spreading.
Beau’s lines and onycomadesis are known to result from the nail matrix arrest which is associated with drug exposures or systemic illnesses including infections. Between August and December of 2009, an outbreak of Beau’s lines and onychomadesis following hand-foot-mouth disease was observed in children and adults in Ehime, Japan. Anti-Coxackie virus A6 IgG neutralizing antibodies were positive in 10 of these patients. This is the first repot of hand-foot-mouth disease with nail matrix arrest in Japan.
A 62-year-old man visited the department of surgery at our hospital with weight loss, liver dysfunction, and an elevation of serum IgG levels, all of which developed in January of 2007. A solitary mass was present in the liver. Histological examination led to a diagnosis of IgG4-related sclerosing cholangitis. The patient began taking prednisolone (PSL: 40 mg/day) in May. When his symptoms improved, the PSL was tapered to 5 mg/day. Itchy eruptions appeared on the patient’s extremities in July of 2008 and spread despite topical application of a glucocorticoid. He presented with small, hyperkeratotic, red papules on the extremities and trunk and scaly erythemas on the scalp. A biopsy specimen showed hyperkeratosis, parakeratosis, acanthosis, and collections of neutrophils in the stratum corneum and stratum spinosum. The dermal papillaries were edematous, and there was a superficial perivascular infiltrate of lymphocytes and plasma cells. These histopathological findings resembled those of psoriasis. There were a few IgG4-positive plasma cells in the dermis, and IgG4 deposition was observed on the vessels in the papillary dermis. We suggest that these psoriasiform eruptions might have been associated with the IgG4-related systemic disease.
This study was conducted to determine the impact of longitudinal changes in psoriasis skin symptoms on quality of life (QOL) among patients with psoriasis. Participants were 228 patients diagnosed with psoriasis. Each participant was asked to respond to the same questionnaire twice at 4 month interval. The data from 115 patients was used for analysis. Concerning PDI, significant gender differences of the mean score were demonstrated in areas of “daily activities” and the total score. As for the impact of longitudinal changes in psoriasis symptoms, for male patients the PDI total score was related to the changes of BSA, Self-BSA, PASI, and Self-PASI, whereas for female patients, the PDI total score was related to the change of Self-BSA. For male patients, the severity of the skin symptoms and changes in the skin symptoms were related to PDI, but for female patients, severity of the present skin symptoms was more strongly related to PDI. The findings of this study illustrate the gender differences in the influences of severity and changes in skin symptoms and will contribute to QOL-oriented care of patients with psoriasis.