Mixed infections of leg, inguinal ulcer and cellulites in HIV patient

Human retrovirus leads to deficiency in the immune system of our body and the body is prone to multiple infections. We present the case of leg ulcer and subsequent development of inguinal ulcer with mixed infections in an immunodeficient patient. The diagnosis was confirmed by serological and bacteriological examination.

Keywords: Human immunodeficiency virus , tuberculosis

Multiple infections are common in immunodeficient patients. Common opportunistic infections, for which normal human beings are not susceptible, quite easily infect a human immunodeficiency virus (HIV) infected patient. Tuberculosis is the commonest infection, which may be focal, disseminated or subcutaneous. Such persons are also prone to multiple bacterial and fungal infections.

This is the case of a 27-year-old male patient with fever for 10 months. Fever was not associated with chill and rigor. He had a small road trauma three months ago, which led to abscess over left calf, cellulites and ulceration recently [Figure 1]. He also developed an inguinal lump two months ago, which became tender and ulcerated with multiple pus points in it [Figure 2]. The patient did not have cough or diarrhea. Past medical history revealed that the patient had developed a splenic abscess in April 2005. He had taken a full course of anti tubercular medicine for lung tuberculosis in 2003; had a history of exposures and was tested sero positive for HIV in February 2007.

The patient was cooperative, conscious and average built. He was severely anemic but with normal pulse and blood pressure. Ultrasound examination showed a few para aortic retroperitoneal lymphadenopathies. His CD 4 count was 126 cells /mm, leg ulcer swab study showed acid fast bacilli and Staph aureus [Figure 3]. His lymphnode biopsy showed a few granulomatous cells with acid-fast bacilli.

The patient was put on antibiotics, antitubercular medicines and drugs for immunodeficiency syndrome. The left ulcer showed significant improvement after 10 days of therapy [Figure 4].

Infection in HIV is atypical and of mixed type. HIV promotes the progress from latent tubercular infection to active disease and tuberculosis is the leading cause of death in people suffering from HIV. ^[1] The course of HIV disease spans a period of 15-20 years and the patient needs a holistic approach in its management and care.^[2] The possibility of dermotomyositis, an autoimmune disease, has also been cited in HIV positive patients. ^[3] As the AIDS epidemic has grown; several skin diseases have an increased prevalence. ^[4] Tuberculosis is the most common opportunistic infection in HIV patients. ^[5] As CD4 count decreases, the patient is much more prone to multiple infections and the load of virus is increased in blood. ^[6] HIV has become a challenging task for all doctors treating it, ^[7] as it is prone to multiple infections. Advanced tuberculosis, disseminated tuberculosis and tubercular skin infections with mixed other infections are common clinical manifestations in HIV patients; ^[8] and management and proper care are needed in treating such patients.

Source of Support: None, Conflict of Interest: None

[Figure 1], [Figure 2], [Figure 3], [Figure 4]