The histopathology of mucous membrane BD lesions are less definite than skin BD.[26] In EQ, there are fewer dyskeratotic cells and multinucleate cells than in BD, with rich plasma cells in the dermis.[14] The EQ associated with HPV infections are undifferentiated, while those related to lichen sclerosus are differentiated.[19] The histopathological differential diagnoses of BD are mentioned in Table 3.[1,2,14,58,72,76,75,78,80,81,82,83,84]
A large percentage of patients with HIV/AIDS will develop dermatological complications. Consequently, all practising clinicians and pathologists in regions with a high prevalence of HIV/AIDS must be familiar with the diverse cutaneous manifestations of the disease. This paper highlights the fact that biopsy material in this clinical context may occasionally reveal more than one pathological process. The potential spectrum includes two or more infections in a single skin biopsy (e.g., herpes simplex and cytomegalovirus infection), neoplastic lesions containing infective organisms (Kaposi sarcoma (KS) and cryptococcosis), dermatoses in association with neoplastic lesions (e.g., KS and interface dermatitis), or more than one dermatosis in a given specimen (e.g., papulopruritic eruption and nodular prurigo). Rare biopsies may even demonstrate triple pathology. The importance of careful examination of skin biopsies in this clinical context is emphasised. Failure to recognise an undiagnosed concomitant opportunistic infective pathogen could have potentially disastrous consequences for the patient.
Mckee S Pathology Of The Skin 4th Edition.13
The wide spectrum of potential colesional skin biopsy pathology is outlined in Table 1. This spectrum encompasses dual noninfective dermatoses, dual or multiple infections, neoplasia (KS) in association with infection, neoplasia (KS) with an associated dermatosis, mixed infective and inflammatory dermatoses, dual neoplastic conditions, and multiple pathologies. Although this latter group is uncommon, a high index of suspicion should always be maintained [1]. In most cases, the detection of more than one pathological lesion in a single biopsy is fortuitous and unexpected. On other occasions, however, a detailed history might reveal that the patient has clinical evidence of more than one type of skin lesion. Some dermatologists may therefore elect to intentionally sample overlapping lesions in a single biopsy [1].
CMV remains the most frequently encountered coincidental pathogen, and whilst its precise pathological significance is often uncertain, one should remain cognisant that the presence of CMV inclusions in a skin biopsy may serve as a sentinel for more serious systemic involvement [3]. The detection of tuberculous granulomas or Cryptococcus organisms in KS has similar implications [3, 4, 36]. Although the patients whose biopsies are illustrated herein were largely HAART-naïve, awareness that colesional pathology may be a rare manifestation of IRIS is appropriate in the era of HAART. A potentially interesting collaborative research opportunity may reside in a detailed clinicopathological analysis of a series of such cases. 2ff7e9595c
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