Bullous disorders as a manifestation of immune reconstitution inflammatory syndrome: A series of three cases
A 38-year-old known HIV positive, Hindu, male, gold smith had a history of sudden loss of weight for last 3 months. Investigations revealed the CD4 T-cell count was 53/μL. HAART was started. Bullous lesion appeared on the trunk and face, 3 weeks after the initiation of HAART. Clinical examination showed multiple erosions and crusted lesions present almost all over the body. The soft palate and inner side of lips were also involved. Nikolsky sign was positive. The CD-4 T-cell was found to be increased to 274/μL. Nevirapine was stopped immediately, but the lesions were persisting. Tzanck smear from fresh lesion showed acantholytic cell under light microscope. Histopathology from a fresh lesion showed intra-epidermal bullae. DIF from perilesional skin showed IgG deposition within the epidermis in lacy pattern. The clinical features and investigations point toward the diagnosis of PV.