THE MISSING PIECE

INTRODUCTION and OBJECTIVE Cutaneous manifestations are one of the indicators of infection from HIV and its progression. The first infection often manifests as a mononucleosis-like syndrome and after a latency period, it starts developing symptoms of immunodeficiency. However, there are primary cutaneous manifestations associated with HIV, such as itching, xerosis, seborrheic dermatitis, psoriasis, atopic dermatitis and eosinophilic folliculitis, which don’t correlate directly with the deterioration of immunodeficiency. METHOD Clinical consultation and case report. RESULTS and CONCLUSIONS Male, 30 years old, single, unemployed. Family classified as nuclear family in the VI stage of Duvall lifecycle. History of asthma and allergic rhinitis, BMI 17. No history of intravenous drug use. He was examined at 7 primary care consultations due to itching in the limbs, with atopic dermatitis diagnosis and folliculitis. The analytical study provided revealed IgE 4,148 kU/L. He was referred to Dermatology and Internal Medicine consultation (Hyper IgE syndrome suspected). In Dermatology consultation HIV status was revelead to be positive. One week later he started antiretroviral therapy. After 3 months, the skin lesions were better and CD4 >500 cells/mm3. When dealing with a patient with atypical skin changes or refractory to therapy, immunodeficiencies must be considered. Sometimes, the cutaneous manifestations of HIV infection are difficult to diagnose. The Hyper IgE syndrome is a rare primary immunedeficiency and its presence was described in advanced stages of HIV infection. The GP should be alert for secondary causes of refractory cutaneous changes and must include HIV in the diagnostic process.