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Biomedical subjects

T G Berger

Publications and source records attributed to T G Berger.

At least 73 records · Page 4Linked to original sources
PubMed1992

Chronic verrucous varicella-zoster virus infection in patients with the acquired immunodeficiency syndrome (AIDS). Histologic and molecular biologic findings.

Verrucous skin lesions have been attributed to various herpes viruses in immunosuppressed patients, including those with human immunodeficiency virus infection (HIV). We examined such lesions from six HIV-infected patients to determine the range of microscopic findings present and to establish which herpesviruses were present. Verrucous epidermal hyperplasia, pseudocarcinomatous hyperplasia, and massive hyperkeratosis correlate with the warty clinical appearance of the lesions. Herpetic cytopathic changes, including multinucleated epidermal giant cells, steel-gray nuclei, necrotic acantholytic keratinocytes, and Cowdry type A nuclear inclusions were seen most prominently in the dells between papillations and in adnexal epithelium. In two cases, increased numbers of spindled cells were seen in the dermis. Immunoperoxidase staining with anti-type IV collagen antibodies demonstrated that these findings were not those of Kaposi's sarcoma, but represent a fibrotic reaction to the infection. Viral cultures of four of the cases demonstrated the presence of varicella-zoster virus, whose presence was detected by the polymerase chain reaction in paraffin-embedded lesional tissue from all six cases. Polymerase chain reaction did not show the presence of cytomegalovirus, herpes simplex, Epstein-Barr, or human papillomavirus. We conclude that these unusual verrucous lesions are a chronic manifestation of herpes zoster infection and that the reported presence of other agents in such lesions is probably coincidental.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Pityriasis rubra pilaris in the setting of HIV infection: clinical behaviour and association with explosive cystic acne.

The development of pityriasis rubra pilaris (PRP) in three patients with human immunodeficiency virus (HIV) infection is described. Two of the patients had onset of severe generalized cystic acne concomitant with their development of PRP. PRP and acne conglobata should be added to the group of cutaneous disorders that can present in a more virulent manner in the setting of HIV infection. The association of cystic acne with PRP and their response to treatment are discussed.

Acne Vulgaris↗
PubMed1992

Chediak-Higashi syndrome in a black child.

Chediak-Higashi syndrome (CHS) is an uncommon genetic disorder with a constellation of clinical, pathologic, and immunologic manifestations. It is rarely reported in blacks. Pathognomonic intracellular inclusions in white blood cells are well recognized; however, characteristic abnormal melanin aggregation into giant melanosomes also occurs, as can be readily seen by histologic evaluation of hair. We present a case of CHS in a black child.

Black People↗
PubMed1992

Drug hypersensitivity reactions and human immunodeficiency virus disease.

Drug hypersensitivity reactions are often observed by clinicians treating patients infected with the human immunodeficiency virus (HIV). For certain drugs, the incidence of these reactions appears to be higher than previously reported in the general population. The best example is trimethoprim-sulfamethoxazole, associated with rash, fever, hematologic disturbances, transaminase elevation, and, less frequently, more severe reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and anaphylactic-like reactions. Other sulfa congeners, pentamidine, antituberculosis regimens containing isoniazid and rifampin, amoxicillin-clavulanate, clindamycin, and thalidomide also have been associated with an increased incidence of adverse reactions, some of which could involve allergic mechanisms. Effective dosage and management strategies are needed to prevent or ameliorate hypersensitivity reactions when they occur.

Drug Hypersensitivity↗
PubMed1992

Nonmelanoma skin cancers and infection with the human immunodeficiency virus.

BACKGROUND AND DESIGN: Forty-eight human immunodeficiency virus-infected patients with nonmelanoma skin cancers seen during a four-year period were evaluated in a retrospective, case-control study. Patients were followed up after therapy and recurrence rates were determined. RESULTS: One hundred and sixteen nonmelanoma skin cancers were identified, 101 of which were basal cell carcinomas (87%), mostly superficial multicentric (67%) of the trunk (62%). There were 15 low-grade squamous cell carcinomas, most commonly of the head and neck. Half of the patients had multiple cancers. Compared with age-matched controls, the patients with skin cancer more commonly had blue/hazel eyes (89% vs 66%; odds ratio [OR] 4.1; confidence interval [CI], 1.25 to 13.44; P = .033), blond hair (42% vs 13%; OR = 4.53; CI, 1.40 to 13.74, P = .003), a family history of skin cancer (45% vs 5%; OR = 11.88; CI, 2.85 to 49.57; P = .00), and a history of regular sunbathing (92% vs 48%; OR = 11.24; CI, 3.17 to 39.83; P = .00). The number of cancers or the presence of squamous cell carcinoma did not correlate with the degree of immunosuppression. The recurrence rate for basal cell carcinomas following standard treatment methods (mostly curettage and electrodesiccation and excision) was 5.4% for those tumors followed up for longer than 12 months. Three of the 15 squamous cell carcinomas recurred, all following curettage and electrodesiccation. CONCLUSION: Nonmelanoma skin cancers are a not uncommon cutaneous finding in human immunodeficiency virus-infected patients. The major risk factors for developing skin cancer in association with human immunodeficiency virus disease seem to be the same as in the normal population--fair skin, a positive family history, and sun exposure. Standard treatment methods seem to be associated with acceptable cure rates, except for squamous cell carcinomas, which had a high (20%) recurrence rate following curettage and electrodesiccation.

Adult↗
PubMed1992

Anetoderma and human immunodeficiency virus infection.

BACKGROUND: Autoimmune disorders such as vitiligo and alopecia areata have been reported in persons infected with the human immunodeficiency virus (HIV). OBSERVATIONS: Three HIV-infected men had anetoderma develop early in the course of their HIV infection. In two patients this preceded other features of HIV disease, and in the third it occurred while the helper T-cell count exceeded 200/mm3. CONCLUSIONS: These findings suggest that anetoderma may be an early manifestation of HIV disease, perhaps autoimmune in its pathogenesis.

Adult↗
PubMed1992

Selective cutaneous hyperpigmentation in mice following zidovudine administration.

BACKGROUND AND DESIGN: C57BL/6N mice fed zidovudine in their drinking water develop selective hyperpigmentation of the tails and footpads. Zidovudine-fed and identical control mice were observed and sequential biopsy specimens were obtained. Routine light microscopy, electron microscopy, and image analysis of unstained biopsy specimens were used to evaluate the extent, nature, and amount of cutaneous hyperpigmentation. RESULTS: Beginning at day 14 selective hyperpigmentation of the tails and footpads of the mice was noted. Histologic evaluation revealed a gradual increase in melanin, beginning in the lower levels of the epidermis, with eventual pigmentation of the stratum corneum. Electron microscopy demonstrated a sixfold increase in melanosomes in the tail skin of the zidovudine-fed mice. Using image cytometry, melanin was quantitatively shown to increase, paralleling the clinically apparent hyperpigmentation. The hyperpigmentation was reversible on discontinuation of zidovudine. CONCLUSIONS: This animal model parallels the human in developing reversible and selective hyperpigmentation on administration of zidovudine. In this model the increased pigmentation is due to increased numbers of melanosomes within epidermal keratinocytes. Image cytometry may be useful in semiquantitatively studying the pathogenesis of various disorders of hyperpigmentation.

Animals↗
PubMed1991

Foscarnet therapy in five patients with AIDS and acyclovir-resistant varicella-zoster virus infection.

OBJECTIVE: To determine whether foscarnet has potential efficacy in the treatment of acyclovir-resistant mucocutaneous varicella-zoster infection in patients with the acquired immunodeficiency syndrome (AIDS). DESIGN: Open-label study. SETTING: Three university medical centers. PATIENTS: Five patients with AIDS who were infected with thymidine-kinase-deficient or -altered strains of varicella-zoster virus. INTERVENTION: Foscarnet, 40 mg/kg body weight every 8 hours in 1-hour infusions for 10 or more days. MAIN RESULTS: Four patients had healing in response to foscarnet therapy, and each of four tested patients became culture negative for virus during foscarnet therapy. Results of fluorescent antigen testing remained positive during therapy in two patients; one of these patients had concomitant clinical failure but the other patient healed fully. One patient had complete healing despite the emergence of resistance to foscarnet in serial specimens obtained during foscarnet therapy. CONCLUSION: Foscarnet is a potentially effective and tolerable antiviral agent for patients with acyclovir-resistant, varicella-zoster virus infection; however, the optimal dosage and duration of therapy require further study, as does the relation between clinical findings and in-vitro susceptibility results.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Identification of herpes simplex virus DNA in lesions of erythema multiforme by the polymerase chain reaction.

An association between erythema multiforme and herpes simplex virus infection has been supported by clinical studies and by the detection by immunofluorescence of herpes viral antigen in sera and skin biopsy specimens of patients with erythema multiforme. In rare cases, the virus has also been isolated in cultures of skin biopsy specimens of erythema multiforme. To investigate further the association between erythema multiforme and herpes simplex virus, we used the polymerase chain reaction for herpes simplex virus to examine skin lesions from patients with erythema multiforme. In this study herpes simplex virus DNA was detected in 11 of 31 biopsy specimens of erythema multiforme; six additional cases showed equivocal amplification results, which is suggestive of low amounts of viral DNA. Seven skin and mucosal biopsy specimens with the histologic changes of herpes virus infection served as positive controls: all were positive for herpes simplex virus DNA. Viral DNA was not detected in control biopsy specimens from skin excised for unrelated conditions. These studies support the association of herpes simplex virus in the pathogenesis of some cases of erythema multiforme. The polymerase chain reaction provides a quick and effective method of detecting herpes simplex virus in lesions of herpes-associated erythema multiforme. Furthermore, the polymerase chain reaction may delineate those cases of erythema multiforme that are etiologically related to herpes virus infection and therefore might be treated with acyclovir to prevent recurrence.

Aged↗
PubMed1991

Orbital dermoid cysts showing conjunctival epithelium.

The orbital area is one of the most common sites for dermoid cysts. Most often these cysts are lined by keratinizing squamous epithelium; however, dermoid cysts may rarely be lined with conjunctival epithelium. We describe such a cyst and the features that distinguish it from other dermoid cysts.

Adult↗
PubMed1991

Epidermodysplasia verruciformis-associated papillomavirus infection complicating human immunodeficiency virus disease.

Three males infected with the human immunodeficiency virus (HIV) were noted to have extensive flat warts of the face and/or body. In two there were also pityriasis versicolor-like lesions. Biopsies showed foamy, basophilic, distended cytoplasm in granular layer keratinocytes, characteristic of the human papillomavirus types seen in epidermodysplasia verruciformis. DNA hybridization techniques demonstrated the presence of HPV-type 8 in one patient and HPV 5 and 8 in another. Patients with immune suppression due to HIV infection may demonstrate the clinical features of epidermodysplasia verruciformis with the same potentially oncogenic HPV types.

AIDS-Related Complex↗
PubMed1991

Dermatophytosis mimicking Kaposi's sarcoma in human immunodeficiency virus disease.

Kaposi's sarcoma (KS) is an important finding in patients infected with human immunodeficiency virus (HIV), with a distinctive spectrum of clinical presentations. Three cases of dermatophytosis in HIV-infected patients are presented which clinically mimic the appearance of KS. This new observation underscores the importance of histopathologic examination in the evaluation of skin lesions suspicious for the diagnosis of KS. The other clinical mimickers of KS are reviewed.

Acquired Immunodeficiency Syndrome↗