Eosinophilic Neuritis and Eosinophilic Panniculitis in a Patient with Advanced Aids

Abstract

A 32‐year‐old immunocompromised African American male on multiple medications with a history of psoriasis and prurigo nodularis presented with a new generalized, painful, pruritic, papular eruption. Histologic sections revealed epidermal changes of lichen simplex chronicus with superficial and deep perivascular infiltrate consisting of lymphocytes and frequent eosinophils. Two important histological features also identified were eosinophilic panniculitis and prominent perineural eosinophilic infiltrate with focal areas showing eosinophils extending into the substance of the nerve. A right thigh sample was also sent for Gram stain, AFB and fungal cultures, all of which were negative. Laboratory findings at this time were significant for a peripheral blood eosinophilia. The patients’ topical corticosteroid prescription was increased with minimal relief. Hypereosinophilic syndrome with dermatoses in HIV infected patients is well documented. We present a patient with advanced AIDS, generalized painful, pruritic, papular rash and peripheral blood eosinophilia. The pattern of inflammation on HIV dermatoses seen in our patient not previously described in the literature is the perineural eosinophilic infiltrate and eosinophilic panniculitis. We propose two possible explanations for these histological findings: (1) hypereosinophilic syndrome in AIDS patients is a heterogeneous disorder and may include eosinophilic neuritis with panniculitis, or (2) an exuberant drug reaction.