Letters to the Editor
66
References 1 Buthani LK. Kanwar AJ, Singh OP: Porokeratosis of Mibelli with unusual features. Dermatológica 1977;155:296-300. 2 Neumann RA, Knobler RM. Gebhart W: Unusual presentation of porokeratosis palmaris, plantaris et disseminata. J Am Acad Der matol 1989;21:1131-1133. 3 Ruocco V, Satriano RA. Florio M, Pettinato G, Pisani M: Porokeratosi palmo-plantare e disseminata con carcinomi a cellule squamose. G Ital Dermatol Venereol 1990;125:53-58. 4 Scappaticci S, Lambíase S, Orecchia G, et al: Clonal chromosome abnormalities with preferential involvement of chromosome 3 in patients with porokeratosis of Mibelli. Cancer Genet Cytogenct 1989;43:89-94. 5 Mitelman F, Heim S: Consistent involvement of only 71 of the 329 chromosomal bands of the human genome in primary neoplasiaassociated rearrangements. Cancer Res 1988;48:7115-7119. 6 Coskey RJ. Mehregan A: Bowen disease associated with porokera tosis of Mibelli. Arch Dermatol 1975;111:1480-1481. 7 Johnston ENM: Porokeratosis of Mibelli with squamous cell carci noma. Br J Dermatol 1958:70:381. 8 Savage J: Porokeratosis (Mibelli) and carcinoma. Br J Dermatol 1964:76:489. 9 Glickman FS: Porokeratosis associated with basal cell carcinoma. Cutis 1982;29:446-449. 10 Machino H, Miki Y, Taramoto T, et al: Cytogenetic studies in a patient with porokeratosis of Mibelli. multiple cancer and a forme fruste of Werner’s syndrome. BrJ Dermatol 1984:111:579-586. 11 Takemiya M. Shiraishi S. Tcramoto T. ct al: Bloom’s syndrome with porokeratosis of Mibelli and multiple cancers of the skin, lung and colon. Clin Genet 1987:31:35—44. 12 Komatsu T. Tamura, S, Kimura S, ct al: Porokeratosis of Mibelli associated with squamous cell carcinoma. Jpn J Clin Dermatol 1983;37:447-452. 13 Guss SB. Osbourn RA. Lutzner MD: Porokeratosis plantaris, palmariset disseminata: a third type of porokeratosis. Arch Dermatol 1971:104:366-373. 14 Shrum JR, Cooper PH, Greer KE, ct al: Squamous cell carcinoma in disseminated superficial actinic porokeratosis. J Am Acad Der matol 1982;6:58-62. 15 Taylor AMR. Hamden DG. Fairburn EA. et al: Chromosomal in stability associated with susceptibility to malignant disease in patients with porokeratosis of Mibelli. JNCI 1973;51:371-378. 16 Otsuka F. Shima A. Ishibashi Y: Porokeratosis as a premalignant condition of the skin. Cytologic demonstration of abnormal DNA ploidy in cells of the epidermis. Cancer 1989:63:891-896. 17 Wolff-Schreiner EC: Porokeratosis; in Fitzpatrick TB, Eisen AZ, Wolff K. Freedberg I. Austen KF (eds): Dermatology in General Medicine. New York. McGraw-Hill. 1987, pp 534-540.
Kaposi's Sarcoma + HIV Infection = AIDS? Sir. Is Kaposi’s sarcoma (KS) associated with human immune defi ciency virus(HIV) infection always diagnostic of AIDSasmentioncd in the revised version of the CDC surveillance case definition [1]? We
believe that the answer to this question is no because of the following case report. In 1981 a 71-year-old man of Italian origin sought medical advice at our dermatology outpatient clinic for a skin lesion on the left foot. It consisted of a bluish macule covered with a purple pediculated tumor of 0.4 cm in diameter and was located on the dorsum of the 2nd toe. Another three small bluish macular lesions were present on the 5th toe as well. Histological examination revealed KS. A lymphography was performed and showed bilateral iliac lymphadenopathies. The patient was considered to be suffering from the Mediterranean form of KS and w'as treated with chlorambucil (4 mg/day) for a few months. He was then lost to follow-up until March 1989 when he consulted us again because of a reoccurrence of tumoral skin lesions on the same foot but had been in excellent health since 1981. There was evidence of exten sion of the disease (KS) to both feet with altogether eight macular and nodular lesions, the largest one measuring 5 cm in diameter and two pediculated and eroded tumors on the 3rd and 5th toe of the left foot. Clinical examination was otherwise unremarkable except for the pres ence of bilateral inguinal lymphadenopathies. Further inquiry then revealed a long-lasting history of homosexuality and a positive serology for HIV since 1986. Total blood count was normal, including lympho cyte count with T helper subset (CD4) at 482/mm1 and suppressor (CD8) one at 1,200/mm\ P 24 antigen was not detected. The two erod ed and bleeding lesions were excised and histological examination was consistent again with the diagnosis of KS. The patient refused any fur ther investigations or treatment. In this case we believe that classical KS is the most likely diagnosis because of the age, sex, origin and type of skin lesions of our patient. In 1981 HIV testing was unavailable and consequently his serological sta tus was unknown. However, it seems that an epidemic form of KS can be further ruled out due to the length of survival, i.e. 8 years and the characteristics of the skin lesions which have remained located on the lower limbs [2], We do not know of any other report in the medical literature con cerning a case of classical KS in association with HIV infection. It is therefore of great interest to note that the behavior of this form of KS docs not seem to have been altered by at least 3 years of coexisting retroviral infection. This case should remind us of the possibility of peo ple suffering from Mediterranean KS to be subsequently infected with HIV. and thorough medical history and clinical examination should be performed before classifying these patients as having AIDS (CDC stage IV D).
M. Harms. S. Kinloch. J.-H. Saurat Clinic and Policlinic of Dermatology University Hospital Geneva (Switzerland)
References 1 CDC: Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR 1987:36:35. 2 Safai B: Pathophysiology and epidemiology of epidemic Kaposi’s sarcoma. Semin Oncol 1987;14(suppl 3):7—12.
66
References 1 Buthani LK. Kanwar AJ, Singh OP: Porokeratosis of Mibelli with unusual features. Dermatológica 1977;155:296-300. 2 Neumann RA, Knobler RM. Gebhart W: Unusual presentation of porokeratosis palmaris, plantaris et disseminata. J Am Acad Der matol 1989;21:1131-1133. 3 Ruocco V, Satriano RA. Florio M, Pettinato G, Pisani M: Porokeratosi palmo-plantare e disseminata con carcinomi a cellule squamose. G Ital Dermatol Venereol 1990;125:53-58. 4 Scappaticci S, Lambíase S, Orecchia G, et al: Clonal chromosome abnormalities with preferential involvement of chromosome 3 in patients with porokeratosis of Mibelli. Cancer Genet Cytogenct 1989;43:89-94. 5 Mitelman F, Heim S: Consistent involvement of only 71 of the 329 chromosomal bands of the human genome in primary neoplasiaassociated rearrangements. Cancer Res 1988;48:7115-7119. 6 Coskey RJ. Mehregan A: Bowen disease associated with porokera tosis of Mibelli. Arch Dermatol 1975;111:1480-1481. 7 Johnston ENM: Porokeratosis of Mibelli with squamous cell carci noma. Br J Dermatol 1958:70:381. 8 Savage J: Porokeratosis (Mibelli) and carcinoma. Br J Dermatol 1964:76:489. 9 Glickman FS: Porokeratosis associated with basal cell carcinoma. Cutis 1982;29:446-449. 10 Machino H, Miki Y, Taramoto T, et al: Cytogenetic studies in a patient with porokeratosis of Mibelli. multiple cancer and a forme fruste of Werner’s syndrome. BrJ Dermatol 1984:111:579-586. 11 Takemiya M. Shiraishi S. Tcramoto T. ct al: Bloom’s syndrome with porokeratosis of Mibelli and multiple cancers of the skin, lung and colon. Clin Genet 1987:31:35—44. 12 Komatsu T. Tamura, S, Kimura S, ct al: Porokeratosis of Mibelli associated with squamous cell carcinoma. Jpn J Clin Dermatol 1983;37:447-452. 13 Guss SB. Osbourn RA. Lutzner MD: Porokeratosis plantaris, palmariset disseminata: a third type of porokeratosis. Arch Dermatol 1971:104:366-373. 14 Shrum JR, Cooper PH, Greer KE, ct al: Squamous cell carcinoma in disseminated superficial actinic porokeratosis. J Am Acad Der matol 1982;6:58-62. 15 Taylor AMR. Hamden DG. Fairburn EA. et al: Chromosomal in stability associated with susceptibility to malignant disease in patients with porokeratosis of Mibelli. JNCI 1973;51:371-378. 16 Otsuka F. Shima A. Ishibashi Y: Porokeratosis as a premalignant condition of the skin. Cytologic demonstration of abnormal DNA ploidy in cells of the epidermis. Cancer 1989:63:891-896. 17 Wolff-Schreiner EC: Porokeratosis; in Fitzpatrick TB, Eisen AZ, Wolff K. Freedberg I. Austen KF (eds): Dermatology in General Medicine. New York. McGraw-Hill. 1987, pp 534-540.
Kaposi's Sarcoma + HIV Infection = AIDS? Sir. Is Kaposi’s sarcoma (KS) associated with human immune defi ciency virus(HIV) infection always diagnostic of AIDSasmentioncd in the revised version of the CDC surveillance case definition [1]? We
believe that the answer to this question is no because of the following case report. In 1981 a 71-year-old man of Italian origin sought medical advice at our dermatology outpatient clinic for a skin lesion on the left foot. It consisted of a bluish macule covered with a purple pediculated tumor of 0.4 cm in diameter and was located on the dorsum of the 2nd toe. Another three small bluish macular lesions were present on the 5th toe as well. Histological examination revealed KS. A lymphography was performed and showed bilateral iliac lymphadenopathies. The patient was considered to be suffering from the Mediterranean form of KS and w'as treated with chlorambucil (4 mg/day) for a few months. He was then lost to follow-up until March 1989 when he consulted us again because of a reoccurrence of tumoral skin lesions on the same foot but had been in excellent health since 1981. There was evidence of exten sion of the disease (KS) to both feet with altogether eight macular and nodular lesions, the largest one measuring 5 cm in diameter and two pediculated and eroded tumors on the 3rd and 5th toe of the left foot. Clinical examination was otherwise unremarkable except for the pres ence of bilateral inguinal lymphadenopathies. Further inquiry then revealed a long-lasting history of homosexuality and a positive serology for HIV since 1986. Total blood count was normal, including lympho cyte count with T helper subset (CD4) at 482/mm1 and suppressor (CD8) one at 1,200/mm\ P 24 antigen was not detected. The two erod ed and bleeding lesions were excised and histological examination was consistent again with the diagnosis of KS. The patient refused any fur ther investigations or treatment. In this case we believe that classical KS is the most likely diagnosis because of the age, sex, origin and type of skin lesions of our patient. In 1981 HIV testing was unavailable and consequently his serological sta tus was unknown. However, it seems that an epidemic form of KS can be further ruled out due to the length of survival, i.e. 8 years and the characteristics of the skin lesions which have remained located on the lower limbs [2], We do not know of any other report in the medical literature con cerning a case of classical KS in association with HIV infection. It is therefore of great interest to note that the behavior of this form of KS docs not seem to have been altered by at least 3 years of coexisting retroviral infection. This case should remind us of the possibility of peo ple suffering from Mediterranean KS to be subsequently infected with HIV. and thorough medical history and clinical examination should be performed before classifying these patients as having AIDS (CDC stage IV D).
M. Harms. S. Kinloch. J.-H. Saurat Clinic and Policlinic of Dermatology University Hospital Geneva (Switzerland)
References 1 CDC: Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR 1987:36:35. 2 Safai B: Pathophysiology and epidemiology of epidemic Kaposi’s sarcoma. Semin Oncol 1987;14(suppl 3):7—12.
