Dideoxyinosine-Associated Ofuji Papuloerythroderma in an HIV-lnfected Patient

Ofuji papuloerythroderma Human immunodeficiency virus Dideoxyinosine Dr. Carlos Ferrándiz, Department of Dermatology, Hospital Universitari Germans Trias i, Pujol, Crta. de Canyet, s/n, E– 08916 Badalona (Spain), Tel. 03 3 465 12 00 (ext. 324), Fax 03 3 395 42 05 Ofuji papuloerythroderma (OPE) is characterized by a widespread pruritic eruption of fixed erythematous papules producing an erythro-derma appearance [1]. A relationship to malignancies and infections has been reported [2, 3], We report a young patient with AIDS who developed – after starting treatment with dideoxyinosine (DDI) – a widespread cutaneous eruption consistent with the diagnosis of OPE. A 31-year-old man presented with a 10-month history of an itching skin eruption. He had been seropositive for human immunodeficiency virus (HIV-1) and chronic hepatitis C virus 4 years before. Since then, the patient has been on dapsone, pyrimethamine and folinic acid treatment. One month before the onset of the rash, treatment with 2’,3’-DDI, 200 mg/l2 h, had been introduced. The rash began symmetrically with erythema and hyperkeratosis on the palms and soles. Five months later, an erythematous rash with pruritic red flat papules appeared on the trunk, which spread progressively over the entire skin surface sparing the head, flexures and body folds, giving to the skin a cobblestone appearance. The mucous membranes were uninvolved. There were some palpable axillar and inguinal lymph nodes. A routine full blood count was normal, except for a lymphopenia with 0.040 × 109 CD4/1, without eosinophilia or abnormal titers of IgE; liver and kidney function tests were also normal. Chest X-ray, total-body bone scanning and bone marrow biopsy showed no abnormalities. A computed tomography scan of the chest and abdomen showed enlarged axillar, inguinal, paraaortic and infrarenal lymph nodes, and hepatosplenomegaly. Histologic examination of a flat papule revealed granulomatous dermatitis with a perivascular and periadnexal lym-phohistiocytic infiltrate (CDS) with eosinophils and occasional multi-nucleated giant cells and Langerhans cells. ß-TCR gene rearrangement studies did not show monoclonality proliferation. Histology of an inguinal lymph node showed dermatopathic lymphadenitis. Treatment with DDI was stopped, and after 2 months of PUVA