Received Date: April 19, 2017; Accepted Date: April 28, 2017; Published Date: May 05, 2017
Citation: Guinard E, Livideanu CB, Lapebie FX, Aleissa M, Paul C, et al. (2017) Palmar Erythema: Inaugural Manifestation of HIV Infection. Dermatol Case Rep 2: 122.
Copyright: © 2017 Guinard E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Acquired palmar erythema can present as a secondary marker of a systemic disease. We report here a case of a 39-year-old male with acquired palmar erythema. The search for etiology revealed an HIV infection. Palmar erythema may be linked to a viral infection but not described with HIV.
Palmar erythema; Human Immunodeficiency Virus (HIV); Viral infection
Acquired palmar erythema (PE) occurs in several physiological and pathological conditions. PE can present as a primary physiological finding or as a sign of underlying disease. The known etiologies include primary cutaneous diseases, systemic diseases, malignancy, infections and drug-induced [1-3]. Among infections, hepatitis B virus and hepatitis C virus are the most recognizable causes . We report here a case of palmar erythema presenting as the initial sign of HIV (Human Immunodeficiency Virus) infection.
A 39-year-old male presented with fixed and painless bilateral palmar erythema for the past two years (Figure 1). His past medical history included seborrheic dermatitis which was treated by zinc and chronic neck pain following a car accident 20 years ago. He also complained of dysesthesia from the left hand up towards the upper arm. On examination, there was bilateral palmar erythema, predominantly on hypothenar eminences and on the palmar aspect of her fingers associated with drug-resistant chronic angular stomatitis and a typical presentation of seborrheic dermatitis. Laboratory findings including complete blood count, erythrocyte sedimentation rate, urea, creatinine, thyroid stimulating hormone, fasting glucose, transaminases and total bilirubin, were within the normal range. Hepatitis B virus serology and hepatitis C virus serology were negative. Immunological work up including antinuclear antibodies, anti-Ro/SSA and La/SSB antibodies and rheumatoid factor, was normal. Liver ultrasound and a Doppler ultrasound of upper limbs were also normal. In addition, electromyogram was performed and did not show any anomalies. However, HIV antibodies was detected using enzyme-linked immunosorbent assay (ELISA), confirmed by Western blot testing. Blood CD4 lymphocytes cell count was 392/mm3. HIV RNA viral load was 107 000 copies/ml. Of note, syphilis tests were negative. The patient linked his primary infection to a sexual intercourse taking place two years back. For HIV treatment, combination therapy by darunavir (protease inhibitor), ritonavir (booster for other protease inhibitors) and tenofovir/emtricitabine (combination of 2 nucleoside inhibitors) was initiated. Marked improvement of erythema and resolution of dysesthesia were seen with a two month follow up. Viral load decreased significantly once we started the treatment.
Palmar erythema had been reported with HBV or HCV [1,4,5] infections, arboviruses  and myelopathy associated with Human T lymphotrophic Virus Type 1 (HTLV-1) virus infection [7,8]. However, to our knowledge, palmar erythema secondary to HIV infection has never been described before.
The physiopathology of palmar erythema is unknown. It can be due to capillary dilatation in the palms and high circulating estrogen levels or by the stimulation of the parasympathetic nerve fibers due to neuropathy secondary to certain viral infections as HIV infection.
Palmar erythema can be a manifestation of HIV infection. Recognition of palmar erythema as a cutaneous sign of HIV infection is important as subsequent HIV screening could lead to an early diagnosis, early control of the disease and could prevent from further contamination.