People living with human immunodeficiency virus (PLHIV) are 100 times more at risk for cutaneous adverse drug reactions (ADRs). Acute generalized exanthematous pustulosis (AGEP) is a rare and severe cutaneous ADR associated with systemic involvement in 20% of cases.

This is a case of a 30-year-old male living with HIV admitted for acute gastroenteritis. Eight hours after initiation of intravenous ciprofloxacin and metronidazole, the onset of generalized monomorphic asymptomatic pustules was observed with associated weakness, fever, thrombocytosis, and neutrophilia. Ciprofloxacin was shifted to piperacillin-tazobactam. The patient was managed with intravenous hydrocortisone and oral cetirizine. Thereafter, the lesions remained stable in size and no new lesions occurred. The patient was referred to the dermatology service for further evaluation and management. A diagnostic workup was done which revealed subcorneal pustular dermatitis on histopathology, no fungal elements on periodic acid-Schiff stain, negative Gram stain, and no growth on culture. This case was diagnosed as AGEP secondary to ciprofloxacin. Dermatologic management consisted of oral antihistamines and topical steroids. The patient experienced generalized desquamation and gradual resolution of pustules over a two-week period with the eventual appearance of normal skin.

Ciprofloxacin is commonly used to treat opportunistic infections in the setting of HIV but it has never been documented to cause AGEP in such settings. Decreased CD4+ T-cell count (460 cells/µL) are factors associated with drug eruptions. Despite its toxic presentation, AGEP has a good prognosis with prompt withdrawal of the offending drug and supportive management.

Human ; Male ; Adult: 25-44 Yrs Old ; Acute Generalized Exanthematous Pustulosis ; Drug Eruptions ; Human Immunodeficiency Virus ; Hiv

Telangiectasia macularis eruptiva perstans (TMEP) is a rare disease, previously classified as a variant of cutaneous mastocytosis. While no gold standard of treatment exists, several treatments have been studied. We report a case of a 63-year-old woman who presented with long-standing asymptomatic telangiectatic macules beginning on the upper chest, back, and bilateral arms, with occasional pruritus and no other systemic symptoms. Skin biopsy, along with Giemsa stain, revealed findings consistent with TMEP. The patient underwent testing for serum tryptase level, which was within normal limits. The patient was started on topical steroids for two weeks and antihistamine therapy, with a noted decrease in pruritus but no change in cutaneous lesions. She was then advised to start phototherapy, and subsequently underwent a total of five sessions of narrow-band ultraviolet B phototherapy, after which she noted lightening of the lesions. Due to the COVID pandemic, the patient was shifted to heliotherapy with continued lightening of lesions after two months of thrice weekly sessions. This rare case is supportive of narrow-band ultraviolet B phototherapy and heliotherapy as promising treatment options for cases of TMEP.
mastocytosis ; phototherapy ; heliotherapy

Although melanoma only accounts for 1% of skin cancers, it is responsible for most skin cancer deaths. Glioblastoma multiforme, a high-grade astrocytoma, is the most aggressive and devastating primary brain tumor. These two diseases remain to be the biggest therapeutic challenge in both specialties of dermatology and neuro-oncology. A 53-year-old Filipino male who presented with a 2-year history of generalized dark brown and black patches on the body developed weakness and numbness of the left extremities. Biopsy and immunohistochemical staining of the skin revealed nodular melanoma with adjacent regressing melanoma. Biopsy of the intracranial mass showed glioblastoma multiforme. One month after the partial excision of the intracranial mass, the patient expired due to brain herniation. Nodular melanoma and glioblastoma multiforme may occur concomitantly in a patient. A review of the literature suggests a shared genetic predisposition. Its existence carries a poor prognosis and requires early detection to start aggressive treatment.
Melanoma ; Glioma ; Glioblastoma ; Association