Reactive Neutrophilic Dermatoses Associated with
Nontuberculous Mycobacterial Infection in
Adult-Onset Immunodeficiency Syndrome
Responded Well to Acitretin: Four Cases Report
Siri Chiewchanvit MD*, Mati Chuamanochan MD*,
Pongsak Mahanupab MD**, Vilai Baosoung MSc***
Affiliation :
* Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
** Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
*** Central Diagnostic Laboratory, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
Background : Recent articles have suggested an adult-onset immunodeficiency syndrome that was described in HIV-uninfected
adults with disseminated non-tuberculous mycobacterial infection and/or another opportunistic infection with concomitant
reactive dermatoses. Few studies reported the drugs used to treat these reactive neutrophilic dermatoses including systemic
steroid, etretinate, clofazimine, colchicine, and dapsone. This study aims to report the efficacy of acitretin for the treatment
of this condition.
Material and Method: Four HIV-uninfected patients with disseminated non-tuberculous mycobacterial infection and the
reactive dermatoses from department of internal medicine, Maharaj Nakorn Chiang Mai Hospital between 2008 through
2011 were observed in the clinical presentation and course of disease including treatment and response.
Results : All patients had at least one episode of reactive dermatoses with variable presentations comprising Sweet’s syndrome
with pustules, pustular vasculitis-like lesions, or generalized pustular lesions. Acitretin was prescribed to treat these reactive
neutrophilic dermatoses. It showed a good response without side effects.
Conclusion : Acitretin, a second-generation retinoid, can be used for the treatment of reactive pustular lesions in the syndrome
of adult-onset immunodeficiency due to its good response, being well tolerated, and without immunosuppression
Keywords : Adult-onset immunodeficiency syndrome, Non-tuberculous mycobacteria, Acitretin, Retinoid, Pustular lesions,
Sweet’s syndrome, Pustular vasculitis, Reactive neutrophilic dermatoses
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