Knowledge of both the common and atypical presentations of human immunodeficiency virus (HIV)-associated dermatoses may be helpful in arousing suspicion of HIV, especially in patients with no reported risk factors. Herein, we report the case of an otherwise healthy, nonpromiscuous 29-year-old man who presented to our institution with an eight-week history of plaques with oyster shell-like scales on the trunk, extremities and genital area. The plaques were associated with fever, and intermittent knee pain and swelling. Initial diagnostic tests were suggestive of drug hypersensitivity syndrome, and the patient's condition improved with treatment using oral prednisone. However, the lesions recurred when the dose of prednisone was tapered, even after the culprit drug had long been discontinued. Repeat skin punch biopsy and arthrocentesis revealed a diagnosis of psoriasis vulgaris with psoriatic arthritis. Due to the atypical presentation of psoriasis, the patient was counselled to undergo HIV testing, which came back positive. Clinicians should be attuned to the skin signs heralding HIV/acquired immunodeficiency syndrome, in order to facilitate early diagnosis and treatment.
Administration, Oral ; Adult ; Arthritis, Psoriatic ; complications ; Biopsy ; Diagnosis, Differential ; HIV Infections ; complications ; diagnosis ; Humans ; Male ; Prednisone ; administration & dosage ; Psoriasis ; complications ; Risk Factors ; Treatment Outcome

BACKGROUND: Vitamin E is a widely available drug widely marketed for alleged cardiovascular benefits. However, recent randomized trials do not show consistent risk reductions in cardiovascular outcomes. A meta-analysis conducted three years ago concluded no benefit in high-risk patients, and that further research on it be abandoned. We felt the need to update this study since there continue to be studies with conflicting findings.OBJECTIVE: This meta-analysis aims to update the investigation on whether vitamin E in high-risk patients causes significant risk reductions in non-fatal myocardial infarction, stroke, cardiovascular death, and all-cause mortality.METHODS: A computerized search of Medline was done using the online PubMed system. Randomized, controlled trials involving high-risk patients including a vitamin E treatment arm and a non-supplemental arm that tested for the specified cardiovascular outcomes were reviewed and appraised independently by three investigators. After quality appraisal and validity assessment, data from the Vitamin E treatment arm and placebo/non-supplementation arm were extrapolated from each study and entered into RevMan 4.2.3. Odds ratios were determined and plotted using a random effects model.RESULTS: Eight randomized controlled trials were included in the study. There were no significant reductions in all-cause mortality (OR=1.02, 95 percent CI 0.98-1.07), cardiovascular death (OR=1.00, 95 percent CI 0.95-1.06) or stroke events (OR=0.97, 95 percent CI 0.89-1.07), or. non-fatal myocardial infarction (OR 0.93, 95 percent CI 0.83-1.04).; Moreover, for non-fatal MI outcomes, statistical heterogeneity was present (Chi2 13.46, p = 0.004, I2 77.7 percent).CONCLUSION: We found no significant reduction in risk for cardiovascular outcomes with Vitamin E supplementation in high-risk patients. We conclude that Vitamin E should not be routinely recommended for high-risk patients.
Vitamin E ; Tocopherol ; Alpha Tocopherol ; Antioxidants ; Stroke ; Myocardial Infarction