Bullous disorders as a manifestation of immune reconstitution inflammatory syndrome: A series of three cases
A 45-year-old, Hindu, male, truck driver was found to be HIV reactive 4 years back. Since then, he was on regular monitoring of CD-4 T-cell count at ART clinic. He had recurrent attacks of loose motion 3 months back. Investigations showed his CD4 T-cell count was 44/μL. Highly active antiretroviral therapy (HAART), comprising zidovudine, lamivudine and nevirapine was started after routine laboratory investigations. After 4 weeks, multiple flaccid bullous lesions appeared on the different parts of the body. Oral and genital mucosa were involved.\nClinical examination showed positive Nikolsky sign. Tzanck smear showed acantholytic cell under light microscope.\nInvestigation revealed increased CD4 T-cell count (252/μL). Incisional biopsy for histopathological examination (HPE) with hematoxylin and eosin stain showed intra-epidermal bullae [] and perilesional punch biopsy for the direct immunofluorescence (DIF) showed intra-epidermal deposition of immunoglobulin G (IgG). Considering all the findings, PV was diagnosed.