Multiple Erythematous Plaques Research Articles

Psoriasis vulgaris developing in healed pemphigus vulgaris: A rare case of epitope spread or isotopic response?

Although psoriasis and autoimmune blistering diseases are considered to be disorders with completely different etiopathogenesis, literature has documented a few cases of psoriasis associated with bullous diseases, particularly bullous pemphigoid. Here, we report the case of a 30-year-old male presenting with multiple flaccid blisters and erosions, clinically and histopathologically consistent with the diagnosis of pemphigus vulgaris. Although all these lesions resolved after two doses of dexamethasone cyclophosphamide pulse therapy, he returned 3 weeks later with multiple erythematous scaly plaques developing over the postinflammatory areas, compatible with the diagnosis of psoriasis vulgaris, which necessitated a modification in the treatment protocol. This rare case highlights the diagnostic and therapeutic challenges accompanying this unique scenario and attempts to elucidate the probable pathogenic mechanisms underlying the co-existence (simultaneous or sequential) of these two apparently unrelated dermatoses.

Bullous prurigo pigmentosa

Prurigo pigmentosa (PP) is an inflammatory dermatosis with unknown etiology. The clinical presentations of PP varies according to the stages of the disease. Rarely, the formation of numerous vesicles and bullae upon erythematous infiltrative plaques can be found during the entire clinical course. In the present case, a 29-year-old Chinese woman presented with a 6-year history of relapsing pruritic erythematous plaques and bulla on her neck, chest and back. Physical examination revealed multiple erythematous plaques and vesicles in combination with mottled pigmentation in a symmetrical distribution and reticular pattern on the nape of her neck, chest and back. Histological examination of the biopsy specimen collected from the bullous area of her chest indicated a lichenoid reaction with intraepidermal bulla. This inflammatory region is characterized by recruitment of lymphocytes, spongiosis, and a perivascular lymphohistiocytic infiltrate in the upper dermis. Direct immunofluorescence analysis for IgG, IgA, IgM and C3 was negative. The diagnosis of bullous prurigo pigmentosa was verified based on the clinical manifestation and pathological findings. Minocycline hydrochloride therapy (100mg/d) was initiated, and 3 weeks later the rash had completely disappeared, which resulted in pigmentation of the entire area. No recurrence was observed during the 4 years follow-up.

Carcinoma of the Esophagus in Patient With Psoriasis: A Case Report

Psoriasis is an immune-mediated, genetic inflammatory disease predominantly affecting the skin and joints. Although various cancers including lymphoma, nonmelanoma skin cancer, and lung cancer among psoriasis patients are more commonly found than the general population; carcinoma of the esophagus has never been reported. The aim of this report was to describe a case of carcinoma of esophagus that was diagnosed in a psoriatic patient. A 50-year-old Thai male presented with epigastric fullness, progressive dysphagia, vomiting, and weight loss for 2 kg within one month. Physical examination revealed multiple erythematous plaques 1 - 3 cm on the trunk and limbs. He had been diagnosed as psoriasis for a year and treated with topical creams. The esophagoscopy revealed the cancer at the lower end of the esophagus that was proved to be poorly to moderately differentiated carcinoma. The computerized tomography of the chest including the upper abdomen showed the esophageal tumor abutting the left bronchus and aorta with multiple lymphadenopathy. He was diagnosed with T3N2M1 stage that was treated with supportive gastrostomy followed by palliative radiotherapy and chemotherapy. Because the carcinoma of esophagus has been hardly reported in psoriatic patients, it could not be easily concluded whether these two entities may have relationship or they just happen by chance.

Nasopharyngeal carcinoma with cutaneous metastases

IntroductionCutaneous metastases from nasopharyngeal carcinoma are extremely rare and associated with a poor prognosis. Case reportsWe retrospectively reviewed 820 patients with nasopharyngeal carcinoma treated over a 20-year period in the radiotherapy department of Farhat Hached hospital in Sousse and Ibn Khaldoun Medical centre, Hammam Sousse. Two of these patients presented cutaneous metastases. The skin lesions appeared during radiotherapy and 3 months after treatment of the primary tumour. Cutaneous metastases present as multiple painless nodules and erythematous plaques. Cutaneous metastases were associated with other metastatic sites (liver, bone). One patient received chemotherapy. Both patients died in a context of rapidly progressive disease. DiscussionNasopharyngeal carcinoma with cutaneous metastases is a rapidly fatal disease. In the light of these two cases and a review of the literature, patients with this disease are aged between 30 and 63 years with a marked male predominance. Cutaneous metastases are correlated with a more advanced primary tumour. The main sites are the trunk and scalp. There is no standard treatment modality for this disease and survival does not exceed 9 months.

Fibroepithelioma of Pinkus masquerading as a widely distributed papulosquamous disease

Fibroepithelioma of Pinkus (FeP) is generally considered a rare tumor that usually presents as a solitary lesion. Multiple tumors are extremely exceptional and usually associated with certain risk factors. We are presenting a peculiar case of FeP presenting with multiple scaly erythematous papules and plaques masquerading as a papulosquamous disease. This patient had no risk factors that could predispose him to develop multiple skin tumors. Up to our knowledge, the case we are reporting is the fourth case in literature of multiple FeP without a history of antecedent radiation and occurring independently of genetics diseases predisposing to skin malignancy.

Summer-Associated Dermatitis: A Cross-Sectional Study of a Unique Eczematous Dermatosis in South India.

Background:In our hospital setup located in the tropical zone, during each summer, we frequently come across a unique eczematous dermatosis among elderly females that typically occur in summer.Aims and Objectives:We carried out this study with the objective of studying the demographic and clinical features of this dermatosis.Materials and Methods:In this hospital-based descriptive study, we enrolled twenty consecutive patients presenting with typical features of the dermatosis of interest, such as itchy eczematous scaly papule and plaques distributed predominantly over flexures, self-limiting in nature, and with summer exacerbation. Detailed history, clinical examination, and laboratory investigations were carried out.Results:All were females with a mean age of 52.35±15.74 years. Mean age at onset of the disease was 50.80±15.77 years. The onset and exacerbation of lesions typically occurred during summer. The mean duration of the disease was 17.75±15.80 months. The typical lesions were multiple well-defined erythematous scaly papules and plaques bilaterally symmetrically distributed predominantly over the flexures. All biopsies showed spongiotic dermatitis picture and direct immunofluorescence was negative in all of them.Conclusion:This unique dermatosis which occurs in elderly females has not been widely reported. With clinical features and results of various investigations, it would be appropriate to call it “summer-associated dermatitis.”

Cutaneous actinomycosis and long-term management through using oral and topical antibiotics: A case report.

Actinomycosis is a subacute or chronic suppurative bacterial infection which caused because of filamentous gram-positive, anaerobic to microaerophilic nonacid fast bacilli primarily of the genus Actinomyces that normally colonize the mouth, colon, and vagina. Primary cutaneous actinomycosis is a rare entity and is generally associated with trauma. A 61- year-old Yemeni male firstly presented to the surgical department in King Fahd Central Hospital with multiple swelling, petted lesions and boring of sensation in the right foot. Local examination showed multiple erythematous nodules and plaques with discharge in the right leg, and active sinus was not determined.

Disseminated cutaneous sporotrichosis: an unusual case

Sporotrichosis is a subcutaneous mycosis caused by Sporothrix schenckii with endemic regions in the American continent. Clinical features depend on the immunological patient state and some characteristics of the fungus. Disseminated cutaneous sporotrichosis is a rare variant usually described in immunocompromised patients. A 42-year-old man was admitted with multiple verrucous and erythematous papules and plaques of the face and limbs. Many lesions showed an ulcerated and crusted component, some papules displayed linear arrangement, and some verrucous plaques exhibited black spots. Skin biopsy revealed pseudoepitheliomatous hyperplasia and granulomas in the papillary dermis. Culture of a skin sample grew Sporothrix schenkii. We report an unusual presentation of disseminated cutaneous sporotrichosis, which was a diagnostic challenge owing to polymorphism and spread of the lesions in a patient without an immunosuppressive state.

Erythema Sweetobullosum a Rare Presentation of Coccidioidomycosis

Background Erythema nodosum (EN) and erythema multiforme (EM) are known reactive cutaneous manifestations of acute infection with coccidioidomycosis. In endemic area, these findings could be diagnostic in the presence of proper clinical presentation. In our experience at Kern Medical similar to our colleagues in Arizona we have observed unique form of cutaneous manifestation of acute coccidioidiomycosis with blisters. This form of skin eruption was given different names such as toxic erythema in 1940 and recently sweet syndrome in 2005. The term erythema sweetobullosum (ESB) was suggested first by David J. Elbaum in 1998 in San Joaquin Valley California in a nine case series. This study showed in contrast to sweet syndrome in ESB histology appears to change based on when the patient is seen. Early on ESB shows lymphocytic dominance, later will be neutrophil rich and eventually histiocytic phase and even granulomatous.Methods Retrospective chart review.ResultsSix cases are identified. Upon presentation they were between 27 and 47 years old half male and other half female. In all cases, ESB lesions were present as multiple tense erythematous plaques base with central crusting and surrounding cluster of vesicular formation. ESB lesions were located on bilateral upper and lower arms in all cases (Figures 1–3). IgM immunodiffusion serology was positive in all cases. Chest X-ray was positive for infiltration or nodule or cavity in five cases. Eosinophilia was present in four cases (800–1600). All cases had EM and two cases had EN present. Histopathology in one case described as subepidermal vesicular dermatitis with lymphocytes and histocytes. No evidence of dissemination was found in all six cases. One case lost follow-up but rest had significant clinical, radiological and serological response to fluconazole therapy with complete resolution of all skin manifestations.Figure 1.45-year-old female with erythema sweetobullosum.Figure 2.42-year-old male with erythema sweetobullosum.Figure 3.40-year-old female with erythema sweetobullosum.Conclusion We are describing six cases of acute pulmonary coccidioidomycosis with unique reactive skin manifestation described as erythema sweetobullosum. The acknowledgment of skin findings assists in prompt clinical suspicious to make diagnosis and initiate treatment.Disclosures All authors: No reported disclosures.

Interstitial granulomatous dermatitis occurring in the patient with breast cancer: report of one case and a review on interstitial granulomatous dermatitis

Interstitial granulomatous dermatitis is a rare skin disorder in which there is a particular pattern of granulomatous inflammationassociated with rheumatologic diseases, hematologic disorders or underlying malignancies. The most common clinical findings ofinterstitial granulomatous dermatitis are multiple erythematous papules or plaques occurring on the varied sites.Histopathologically, it is characterized by dense perivascular and interstitial histiocytic infiltration around focally degeneratedcollagen fibers in the reticular dermis. We present a case of interstitial granulomatous dermatitis occurring in the patient withbreast cancer.

An extremely rare association of Sweet's syndrome with active pulmonary tuberculosis

Sweet's syndrome is a skin manifestation of various systemic infections, drugs, malignancies and autoimmune disorders. There are very few case reports describing the relationship between Sweet's syndrome and non-tubercular mycobacterium infection. Further development of Sweet's syndrome secondary to mycobacterium tuberculosis (active pulmonary tuberculosis) is extremely uncommon and this is the second well established case reported from India. Here we report a forty eight year old man who presented with multiple erythematous and tender plaques over neck, palms and sides of soles. He also had high grade fever, headache, myalgias, cough, chest pain and difficulty in breathing. With clinical possibilities of (1) Sweet's syndrome with pulmonary involvement and (2) Sweet's syndrome secondary to pulmonary infection, we send the skin biopsy for histopathological examination and also advised routine laboratory plus imaging investigations to find out the underlying cause. Clinical and lab parameters together with the biopsy report fulfilled the diagnostic criteria for Sweet's syndrome. Further chest X-ray findings, demonstration of acid fast bacilli of mycobacterium tuberculosis on sputum smear microscopy and MGIT report confirmed the diagnosis of pulmonary tuberculosis. Patient was put on colchicine and standard anti-tubercular drugs. Significant improvement was noticed in skin lesions within five days of treatment and no recurrence has been seen for the past six months.

Subcutaneous panniculitis-like lymphoma in a 3-year-old child

Panniculitis-like T-cell lymphoma is a rare cytotoxic T-cell lymphoma of the skin involving the subcutaneous tissue. We report panniculitis like lymphoma occurring in a 3 year old female child.She presented with multiple erythematous tender nodules and plaques on face,right thigh and genital region associated with systemic symptoms.The histopathology revealed lobular panniculitis composed of atypical lymphocytes . Immunophenotypic studies showed that the atypical lymphocytes are positive for CD3&CD8 and negative for CD20. The child improved with systemic antibiotics and supportive therapy. Now child is on regular follow up for the past four months without any new lesions.

Retraction note: Cyto-histopathological and outcome features of the prepuce squamous cell carcinoma of a mixed breed dog.

Squamous cell carcinomas (SCCs) are uncommon, high-grade tumors, predominantly composed of round cells in the prepuce. The aim of this study is to better define the clinicopathologic features of this neoplasm. We conducted cyto-histopathologic analysis on the manifestations of the prepuce SCC by H & E staining in a terrier mix dog. Grossly, tumor was large, multiple erythematous patch, and ulcerated masses frequently affecting the prepuce and deeply invading to distal prepuce out from the ventro-lateral of penis and the tumor covered by a necrotic discharge. Cytological evaluation of fine-needle aspirates from the cutaneous mass from the prepuce comprised of round nuclei, coarse chromatin pattern, distinct nucleoli and nuclear pleomorphism. Furthermore, the neoplastic cells were pleomorphic, round to caudate in shape, exhibiting prominent anisokaryosis and anisocytosis with rare mitotic features. Microscopically, the lesions were predominantly composed of atypical round cells disposed in interlacing fascicles. Frequent findings include keratin formation, horn pearls, mitoses and cellular atypia. The cells showed distinct borders, ranged from polygonal to round or elongate and had moderate amounts of eosinophilic cytoplasm. The histopathologic features coupled with the cytopathology findings led to a diagnosis of squamous cell carcinoma. To the authors’ knowledge, this is the first time that multiple erythematous plaques have undergone malignant transformation in a terrier mix dog. The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5748771971272873

Clinical and pathological analysis of 7 cases of primary cutaneous CD30+ anaplastic large cell lymphoma

Objective To investigate clinical and pathological features of primary cutaneous CD30+ anaplastic large cell lymphoma (PC-ALCL). Methods Clinical and pathological data were collected from 7 patients with PC-ALCL and analyzed retrospectively. Results Of the 7 patients, 6 were male and 1 was female, with an average age of 52 years. PC-ALCL was characterized by solitary (n = 3) or multiple (n = 4) erythematous nodules, lumps and/or plaques with (n = 6) or without (n = 1) ulceration. Systemic involvement was observed in none of the 7 patients. Histopathological examination showed diffuse distribution of tumor cells in the dermis, which were large with rich cytoplasm and atypical nuclei. Mitotic figures were seen. An immunohistochemical study of tumor cells showed positive staining for CD30 and cytotoxic protein, but negative staining for CD20, CD56, anaplastic lymphoma kinase (ALK). Epstein - Barr virus - encoded RNA in situ hybridization was negative. Conclusions PC - ALCL is a rare primary cutaneous low - grade malignant T - cell lymphoma, which can be confirmed by clinical manifestations as well as histopathological and immunohistochemical examinations. It usually has good prognosis with rare systemic involvement and metastasis. Key words: Lymphoma, primary cutaneous anaplastic large cell; Skin manifestations; Pathologic processes

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Bullous Wells’ syndrome

Wells’ syndrome (WS) is an uncommon inflammatory skin disease which typically presents single or multiple erythematous and edematous urticarial plaques similar to cellulitis. The lesions may evolve into blue-grey morphea-like lesions and may persist for weeks or months. They ultimately heal without scar. Other clinical presentations reported in literature include papular and nodular and, rarely, bullous eruptions. Previously, bullous Wells’ syndrome was rarely reported in the literature. Herein, we describe a case of a female patient with bullous Wells’ syndrome localized to the upper limbs without any associated disorders.

Interstitial Granulomatous Dermatitis Associated with Rheumatoid Arthritis.

Dear Editor: Interstitial granulomatous dermatitis (IGD) is a rare and peculiar disorder with cutaneous and joint manifestations1. IGD may be associated with rheumatologic and hematologic disorders of underlying malignancies2,3. Herein, we report a case of IGD associated with rheumatoid arthritis (RA). A 59-year-old Korean woman presented with multiple erythematous plaques on both extremities for 10 days (Fig. 1A). Upon physical examination, the plaques were linear shaped, non-tender, and palpable. She had been diagnosed with RA 17 years earlier. She had taken prednisolone, nonsteroidal anti-inflammatory drugs, and methotrexate to treat RA for 7 years. One month earlier, her arthritis symptoms had stabilized and the rheumatologist withdrew methotrexate. Laboratory test findings were non-specific except for an elevated C-reactive protein (CRP) level (7.12 mg/dl; normal range, 0.01~0.47 mg/dl) and erythrocyte sedimentation rate (ESR) (81 mm/h; normal range, 0~15 mm/h). Histopathologic findings indicated perivascular and interstitial lymphohistiocytic infiltration through the dermis and chronic granulomatous inflammation with collagen degeneration in the upper dermis. Immunohistochemically, most of the infiltrating inflammatory cells were CD 68-positive. Alcian blue staining revealed no mucin deposition in the areas of granulomatous inflammation (Fig. 2). Based on clinical and histological findings, she was diagnosed with IGD. A 7.5-mg methotrexate dose was given weekly and the daily prednisolone dose was increased from 5 mg to 15 mg. A topical 0.1% tacrolimus ointment and methylprednisolone cream were also applied daily for 2 months. The lesions were nearly cleared and ESR and CRP were found to be within normal limits after 2-month follow-up (Fig. 1B). Fig. 1 (A) Multiple, erythematous, palpable, and linear shaped plaques on both extremities. (B) Nearly clearing of lesions after a 2-month follow-up. Fig. 2 (A) A perivascular and interstitial lymphohistiocyte infiltration in the entire dermis (HE B: ×100, C: ×400). ... The most common clinical findings of IGD are asymptomatic multiple papules and plaques (70%~90% of cases)2. The rope sign was named for the linear prominent cutaneous cord-like lesions, considered pathognomic for IGD1. However, these lesions are not an essential feature, and are reported in only 9% of cases3. The histopathologic findings show interstitial CD 68-positive histiocyte infiltration around focally degenerated collagen2,4. Epidermal changes, mucin deposition, neutrophil and/or eosinophil infiltration, and vasculitis are usually absent 2. Differential diagnoses include interstitial granuloma annulare (IGA), interstitial granulomatous drug reaction (IGDR), and palisaded neutrophilic and granulomatous dermatitis (PNGD)1,2,4. In IGA, prominent mucin deposition and only focal interstitial infiltration could be found. Recent change of medication is present in IGDR, and IGDR presents with basal cell vacuolization and lichenoid changes with eosinophils2. Leukocytoclastic vasculitis and pandermal infiltration of neutrophil frequently present in early lesion of PNGD, and palisading granulomatous inflammation is the typical feature of fully developed one1. The pathogenesis of IGD may be associated with immune complex deposition caused by immune reactants of systemic inflammatory diseases5. Interestingly, IGD lesions in our case began to occur in association with the flare-up of RA after methotrexate withdrawal, although the causal relationship remains unknown. From our case we suggest that IGD should be considered among the differential diagnoses for patients with rheumatologic disease and cord-like skin lesions.

Tufted angioma.

Sir, An 18-year-old female presented with multiple red raised lesions over the neck since the age of eight years. There was no history of trauma, bleeding from the lesions, or excessive sweating. There was no history of similar complaints in the family. Cutaneous examination revealed multiple erythematous and skin-colored plaques on the neck [Figure 1]. The lesions were firm, nontender, noncompressible, and warm on palpation. There was no thrill or bruit over the plaque. Systemic examination did not reveal any abnormality.Figure 1: Erythematous papules and nodules on the neckSkin biopsy from the nodule revealed clusters of numerous dilated, thin- and thick-walled capillaries within the dermis [Figures 2 and 3]. The capillaries were lined by plump or elongated endothelial cells. Some of the capillaries with thick walls were engorged with RBCs. The dermis surrounding these clusters revealed fibroplasia. Overlying epidermis showed mild hyperplasia.Figure 2: Clusters of dilated capillaries in the dermis (hematoxylin and eosin ×10)Figure 3: Dilated capillaries (hematoxylin and eosin ×40)Tufted angioma (TA) is a rare, benign angiomatous condition. It is also called angioblastoma of Nagakawa. It affects both the genders equally. The lesions usually arise between the ages of 1 and 5 years. Occasionally, the lesions may be present at birth.[1] They may rarely develop in adults or in old age. Partial spontaneous regression of TA may occur, but complete disappearance is extremely rare.[2] Clinically, the lesions are characterised by erythematous papules, plaques, and nodules. Atypical presentations of annular plaques may be seen. The most commonly involved sites are neck, upper trunk, and proximal part of extremities.[2] The lesions may show increased sweating, or growth of fine lanugo hair. Kasabach–Merrit phenomenon, which is characterized by trapping of the platelets in the vasculature and thrombocytopenic coagulopathy leading to petechiae and ecchymosis is a known though uncommon complication of tufted angioma. Histopathologically, tufted angioma is characterized by well-circumscribed foci of clustered capillaries in the dermis and the subcutaneous tissue. The capillaries are lined by plump or elongated endothelial cells. These ovoid tufts of capillaries give the “cannonball appearance” to the angiomatous structures. There is no mitotic activity or atypia in the cells. It is important to differentiate tufted angioma from Kaposi's sarcoma, kaposiform hemangioendothelioma, and low-grade angiosarcoma, especially in adults. Kaposi's sarcoma shows spindle-shaped endothelial cells with slit-like spaces and the promontory sign. Kaposiform hemangioendothelioma shows a lobular and infiltrative pattern, whereas differentiation from low-grade angiosarcoma can be done by the absence of atypia and mitotic figures. The various treatments that have been employed for tufted angioma include potent topical steroids, systemic steroids, interferon alpha, complete surgical excision, cryosurgery, radiotherapy, and pulsed dye laser.[3] However, the rate of recurrence is high.

Marshall's syndrome

Marshall's syndrome is a form of acquired cutis laxa without systemic involvement. It is characterized by acute onset of multiple erythematous papule and plaques that resolve with postinflammatory elastolysis and cutis laxa. We report a case of 4-year-old boy with the typical features of Marshall's syndrome.

Triple secondary neoplasms

Pegylated liposomal doxorubicin (PLD) is a first-line therapy for AIDS Kaposi's sarcoma [1]. Kaposi's sarcoma lesions contain dilated vascular spaces with extravasated erythrocytes; PLD uptake due to extravasation of liposomes was anticipated, offering advantage over conventional formulation. Skin Kaposi's sarcoma biopsies of patients under PLD reached 10–20 times doxorubicin concentrations to that of the normal skin [1]. Complete regression of Kaposi's sarcoma solely with highly active antiretroviral therapy (HAART) has been reported [2–5], questioning the need of chemotherapy for this angioproliferative disease produced by human herpes virus 8, as chemotherapy can increase immunosuppression. Worsening of Kaposi's sarcoma after HAART initiation is a manifestation of immune reconstitution syndrome [6,7], and without visceral involvement, it is a limited phenomenon; as immune function recovers, Kaposi's sarcoma regresses without further therapy. Secondary malignancy is a concern from chemotherapy use, but its role is difficult to demonstrate as other factors can contribute to its development. A substantial high incidence of secondary neoplasms – 9% among Kaposi's sarcoma patients treated with PLD – was recently reported [8], and oral cavity squamous cell carcinoma has also been reported in PLD-exposed patients [9–12], raising concerns of a possible contributing effect of PLD in the development of these neoplasms. Here, we present the case of a 37-year-old man with a 20-year history of cigarette smoking (average 5 cigarettes per day), who was diagnosed with AIDS on May 2011; he presented with wasting syndrome, oropharyngeal-candidiasis, disseminated-Mycobacterium avium Intracelulare and cutaneous Kaposi's sarcoma. His viral load was 631 471 copies/ml and CD4+ 144 cells/ml. The patient was started on Truvada + Kaletra and, 4 months later, the viral load was undetectable and the CD4+ had risen to 196 cells/ml. Following this, he received five monthly cycles with bleomycin 17 units, vincristine 2 mg and dexamethasone 16 mg, after which monthly PLD was started. On October 2012, after eight cycles of PLD, the patient noted multiple erythematous plaques in his penis; his HIV viral load remained undetectable, but he had 73 cells/ml CD4+. A penis biopsy revealed epidermoid carcinoma, which was successfully treated with topical 5% fluouracil. In November 2012, the patient complained of lip and oral mucosa lesions, for which the biopsies reported high-grade dysplasia. Several variants of HPV were identified: in the penis carcinoma and ureteral smear 16, in lips 33 and 35, in oral mucosa 35, in fresh oral mucosal smear 16 and 33, and in perianal condylomas 16 and 11. To our knowledge, there are no reports on adverse effects of PLD in HIV patients with concomitant mucosal HPV infections. However, since PLD concentrates for prolonged periods in mucous membranes, it is likely that it might alter local immunity since. PLD immunosuppression could also increase HPV replication [13], and decrease CD4+ cell counts [8] as for the case herein reported, in whom despite HIV viral suppression, CD4+ cells decrease with PDL administration (Fig. 1).Fig. 1: Temporal events of patient's case.Administration of chemotherapy*: (1) bleomycin 17 mg + vincristine 2 g + dexamethasone 16 mg (5 cycles); (2) pegylated liposomal doxorubicin (PLD) 60 mg + dexamethasone 16 mg (10 cycles). Red line, HIV viral load; blue diamonds, CD4+ cell count; pink bars, accumulated PLD. (a) Hematoxylin and eosin (HE) 40×. Penis mucosa with marked cytological atypia involving the entire epithelium. Note numerous atypical mitosis in the upper zones. *In-situ epidermoid penis carcinoma, human papillomavirus (HPV)16+. (b) HE 10×. Lip mucosa with acanthosis, cytologic atypia involving half epithelium. Note koilocytosis in the upper. High grade dysplasia (HGD) of the lip HPV 33 and 35+. (c) Oral mucosa. HE 4× and Ki67 immunostain. Oral mucosa with irregular acanthosis and cytologic atypia. Involving more than half of the epithelium. Note Ki67 positive in the entire epithelium, HGD of oral mucosa HPV35+.Although there has been an increasing incidence of non-AIDS-defining malignancies in the HAART era, the incidence of cancers of the oral cavity and penis in HIV patients is rare (<1%) [14]. Kaposi's sarcoma remission can be achieved solely with HAART and thus the use of PLD in AIDS Kaposi's sarcoma should be questioned since it can chronically affect the control of HPV infection and thus increase the risk of HPV-related neoplasms. Acknowledgements Conflicts of interest There are no conflicts of interest.