Bone Pathology Database

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2nd image
Photograph after shoulder disarticulation
He was HIV positive, and had a CD4 count of 94.
On examination had nodular, pustular skin lesion from hand to axilla as well as established gangrene of the hand and forearm.
Biopsy confirmed Kaposi's Sarcoma.
A disarticulation of the shoulder was done as there was vascular compromise and gangrene of the forearm. The patient died about three months after this.

KS cases have developed in association with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS), especially among homosexual men.
This disease typically causes tumors to develop in the tissues below the skin surface, or in the mucous membranes of the mouth, nose, or anus. These lesions (abnormal tissue areas) appear as raised blotches or nodules that may be purple, brown, or red. Sometimes the disease causes painful swelling, especially in the legs, groin area, or skin around the eyes.

Other skin manifestations of AIDS
1) Psoriasis
This is probably not increased in prevalence but may become worse or appear for the first time during HIV infection. Psoriasis manifesting after development of HIV infection appears slightly different in character with more common involvement of palms and soles and associated arthritis, similar to Reiters syndrome. Family history of psoriasis is also less common in this group.
2) Drug allergies
HIV infection is associated with a nonspecific polyclonal gammopathy as result of diminished T cell control of B cell function. The ensuing atopic state with hyper-responsiveness to allergens leads to increased risk of adverse reactions to drugs with allergies more common during early and particularly middle periods of HIV infection. With severe immunodepression, capability of mounting such a response diminishes.
3) Molluscum contagiosum
These pox virus-associated hard cream coloured umbilicated papules may be seen in on the skin of atopic children, or more sparsely as a venereal infection around the normal adult perineum. In HIV infection, as the CD4 count declines below 100, scores of mollusca may appear, often on the face and mantle area. 4) Viral warts
Human papilloma virus is a common skin pathogen in HIV infection, and the resulting often multiple verrucous warts are difficult to treat.

Record 25