PIGMENTED ERYTHRODERMAS IN AIDS - 5 CASES

Introduction. We report five cases of pigmented erythroderma occuring during AIDS, noteworthy for its unusual hyperpigmented feature, its ad vent at the terminal stages of AIDS, and an CD8 cells dermal infiltrat e. Patients and methods. It is a retrospective study of five patients infected with HIV: a woman infected by transfusion and four homosexual men, average 55 years old. No one was intravenous drug user. They wer e all severely immunocompromised; HTLV I/II serology was negative. Ski n biopsies were studied with light microscopy (Hematoxylin-eosin) and immunohistochemical studies were performed on frozen sections. Results . The patients had an erythroderma of particular interest because of t he associated hyperpigmentation, the severe repercussion (pruritus, we ight loss), and the difficulty in treating (except systemic corticoste roids). The histology demonstrated a mononuclear dermal lymphocytic in filtrate, without epidermotropism and atypical cytonuclear feature. Th e phenotype of the infiltrate was uniformly of the suppressor-cytotoxi c subset (CD8+, CD4-). Comments. Our cases are like those previously d escribed as ''Pseudo-Sezary'', mimicking a lymphoma during AIDS. Numer ous factors are probably the cause of this hyperpigmented erythroderma : HIV, CD8 cells... Conclusions. This severe skin disease, complicatin g AIDS, seems very particular, but not yet clearly defined. In practic e, the problem remains the treatment of this severe erythroderma, beca use only the systemic corticosteroids are effective, but this is debat able during the treatment of AIDS.