Pityriasis rosea in a patient with retrovirus infection and a history of syphilis and positive results of infection with hepatitis A virus, hepatitis B virus and hepatitis C virus

Skin changes in the course of human immunodeficiency virus (HIV) infection appear to be a common phenomenon. According to different sources, such changes present in more than 90% of patients with the retroviral infection [1, 2]. Often these skin lesions are the first sign of immunosuppression and contribute to the onset of diagnostic tests in the direction of immune disorders [1–3]. It is believed that the dermatological symptoms in the course of HIV infection may be primarily related to infection with the virus or a secondary result of immunosuppression in the course of the disease [2]. An important issue is the occurrence of drug-induced skin changes associated with antiretroviral therapy and the treatment of diseases associated with HIV-positive patients, which can present in various forms.
A 34-year-old male patient presented to the dermatological emergency room due to scattered lesions, the first onset of which occurred about 4 weeks before. On interview, the patient reported a previous viral infection of the upper respiratory tract shortly before the onset of rash, and contact with animals (dogs, cats). In addition, he was infected with HIV (Stage A3 – according to the CDC AIDS classification, diagnosed in 2003), hepatitis B virus (HBV), hepatitis C virus (HCV) and had an illness history of syphilis (2009) and hepatitis A virus (HAV) infection. Furthermore, the examination of the patient’s condition revealed hypertension, smoking, varicose veins of the lower extremities. The patient remains under control of the Acquired Immunodeficiency Clinic.
On admission, the patient’s general condition was stable and without fever. On the skin’s surface of the front and back of the trunk and upper and lower limbs, there were numerous eruptions of well-demarcated erythematous plaques of the circular or elliptical shape, with a gentle scaling on the surface and mild pruritus. (Figure 1).
Deviations observed in laboratory tests include: elevated liver enzymes, increased red blood cell volume and slightly elevated IgE antibody titer. Serological studies found: positive anti-HAV IgG, positive anti-HCV, anti-HBc and anti-HBs, and positive syphilitic reactions (TPHA, FTA-ABS). RNA viral load of HIV was below the cut-off point, while the number of CD4+ lymphocytes was 42 cells/mm3 and CD8+ was 733 cells/mm3.
Mycological examinations of scrapings taken from the lesions (direct preparation and culture were negative) and Wood’s lamp examination...


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