MUCOCUTANEOUS MANIFESTATIONS IN 22 CONSECUTIVE CASES OF PRIMARY HIV-1INFECTION

Twenty-two consecutive patients presenting with symptomatic human immu nodeficiency virus 1 (HIV-1) seroconversion were studied. Most of the patients had a glandular fever-like illness. All patients had fever an d pharyngitis, and eight of them also suffered from ulcers of the oral , genital or anal mucosa. Uniform skin eruptions were observed in 17 o f the 22 patients. The exanthem consisted of varying numbers of macula r or maculopapular lesions that were oval or rounded in shape, ranging from a few millimetres to 1 cm in diameter, The lesions were distribu ted on the upper thorax in all cases, and were particularly profuse in the collar region. The face, forehead and scalp were involved in most cases, but the eruption was sparse or absent at the periphery of the extremities. In the majority of patients, the exanthem appeared after 2 or 3 days of fever. The exanthem developed during the first day, per sisted for 5-8 days, and then cleared concurrently with the general re covery of the patients. Histopathological studies of skin punch biopsy specimens from four patients showed a sparse lymphocytic cell infiltr ate distributed around vessels of the dermal superficial plexus. The i nfiltrates predominantly consisted of equally represented T-helper/ind ucer and T-suppressor/cytotoxic cells. A vacuolar aberration of basal layer cells was found in two of the four cases studied histologically. The microscopic findings correspond to the histopathological patterns seen in toxicodermia and in the interface dermatitis of morbilliform viral exanthems. The exanthem is a frequent and characteristic sign of primary HIV infection, which is further indicated if mucosal ulcers a re present.