An autoimmune quandary: discoid lupus erythematosus and HIV coexistence in an Indian patient
Keywords:
Human immunodeficiency virus, discoid lupus erythematosusAbstract
The development of autoimmune diseases in the backdrop of an immune dysfunction in patients with human immunodeficiency virus (HIV) infection is intriguing. An infectious trigger for immune activation is one of the postulated mechanisms and derives from molecular mimicry. Progression from HIV infection to AIDS is associated with a gradual loss of immune-competence. Immune dysregulation and persistent, prolonged immune activation leads to autoimmune phenomena such as lupus and serological abnormalities. We report this sui generis case of discoid lupus erythematosus in HIV positive Indian male for its sheer clinical charm. We also discuss on the probable etiopathogenesis which has not been confounded together so far.References
Colon M, Martinez DE. Clinical remission of systemic lupus erythematosus after human immunodeficiency virus infection. Puerto Rico Health Sci J. 2007;26:79-81.
Mongey A, Hess EV. The role of environment in systemic lupus erythematosus and associated disorders. In: Wallace DJ, Hahn BH, editors. Dubois. Lupus Erythematosus. 6th edn. Philadelphia: Lippincot Williams and Wilkins; 2002. p. 33-64.
Vin-Christian K, Epstein JH, Maurer TA, McCalmont TH, Berger TJ. Photosensitivity in HIV-infected individuals. J Dermatol. 2000;27:361-9.
Calza L, Manfredi R, Colangeli V, D'Antuono A, Passarini B, Chiodo F. Systemic and discoid lupus erythematosus in HIV-infected patients treated with highly active antiretroviral therapy. Int J STD AIDS. 2003;14:356-9.
Eggena MP, Barugahare B, Jones N, Okello M, Mutalya S, Kityo C et al. Depletion of regulatory T cells in HIV infection is associated with immune activation. J Immunol. 174:4407-14.
Franz B, Fritzsching B, Riehl A, Oberle N, Klemke C-D, Sykora J et al. Low number of regulatory T cells in skin lesions of patients with cutaneous lupus erythematosus. Arthritis Rheum. 56:1910-20
Vin-Christian K, Epstein JH, Maurer TA, McCalmont TH, Berger TG. Photosensitivity in HIV-infected individuals. J Dermatol. 2000;27:361-9.
Gould T, Tikly M. Systemic lupus erythematosus in a patient with human immunodeficiency virus infection –challenges in diagnosis and management. Clin Rheumatol. 2004;23:166-9.
Stevens RJ, Andujar C, Edwards CJ, Ames PR, Barwick AR, Khamashta MA. Thalidomide in the treatment of the cutaneous manifestations of lupus erythematosus: experience in sixteen consecutive patients. Rheumatology. 1997;36:353-9.
Bhagwat PV, Kudligi C, Shashikumar BM, Thirunavukkarasu A, Shendre MER. Extensive discoid lupus erythematosus in a HIV patient responding to hydroxychloroquine monotherapy. Indian J Dermatol. 2012;57:326-7.
Zandman G, Shoenfeld Y. HIV and autoimmunity. Autoimmun Rev. 2002;1:329-37.
