Bullous disorders as a manifestation of immune reconstitution inflammatory syndrome: A series of three cases
A 42-year-old known HIV positive, Hindu lady showed CD4 T-cell count 50/μL during her 6 monthly routine follow-up. HAART was started with Zidovudine, Lamivudine and Nevirapine. After 8 weeks, she came to dermatology out-patient department with the complaints of multiple reddish, itchy rashes on the different parts of the body. They were transformed into bullous lesions within 2-3 days. Nevirapine was stopped immediately, but the lesions were persisting. Investigation revealed CD4 T-cell count was 260/μL. Clinical examination showed the multiple tense bullous having round margin and appeared on erythematous urticarial base on the skin. Mucosa were not involved. The bullous spread sign was positive, but Nikolsky sign was negative. Tzanck smear showed no acantholytic cell. HPE revealed sub-epidermal bullae [] with eosinophilic infiltrate. IgG and C3 deposition was found at the dermo-epidermal junction on DIF. Hence BP was diagnosed.