HISTOLOGICALLY DISTINCTIVE PAPULAR NEUTROPHILIC XANTHOMAS IN HIV-1+ PATIENTS

Xanthomas may be associated with benign or malignant lymphoproliferati ve diseases, often with associated hypergammaglobulinema. In human imm unodeficiency virus type 1 (HIV-1) disease, there is a high lymphoprol iferative rate despite the immunodeficiency and increased cell death. We report three HIV-1-positive patients with facial papular xanthomato sis eruptions associated with hypergammaglobulinema, and an immunoglob ulin A (IgA) gammopathy. Histopathologic features include lipid-laden macrophages, extracellular nuclear dust with phagocytosized nuclear de bris, and hyalinization with areas of hyaline necrosis of collagen fib ers. These distinctive papular xanthomas may be a marker of HIV-1 dise ase and of a pattern of immunodysregulation, immunodeficiency, and lym phoid proliferation seen in HIV-1 disease.