Inguinal Ulcers in a Patient with HIV Infection

Dear Editor, A 21-year-old male patient was admitted with mild traumatic brain injury following a traffic accident. During hospitalisation, he developed sepsis of pulmonary origin, which was managed with antibiotics. Additionally, he was diagnosed with de novo human immunodeficiency virus (HIV) infection, with a viral load of 894,685 copies/mL and a CD4 T lymphocyte count of 195 cells/µL. Additionally, opportunistic infections such as tuberculosis, histoplasmosis, cryptococcosis, cytomegalovirus infections, syphilis, and viral hepatitis were ruled out. Since admission, the patient reported the presence of round, painful ulcerated plaques in both inguinal folds [Figure 1a and b], with no known temporal onset. Due to the possibility of a deep fungal infection or pyoderma gangrenosum, a histopathological examination was performed, revealing an epidermal ulcer with a neutrophilic infiltrate, thus confirming the diagnosis of pyoderma gangrenosum [Figures 2 and 3]. Antiretroviral therapy consisting of dolutegravir, tenofovir, and emtricitabine was initiated, leading to improvement in the inguinal lesions. After 4 months, the lesions had fully healed [Figure 1c], establishing the diagnosis of pyoderma gangrenosum associated with HIV.Figure 1: (a and b) Ulcers with well-defined edges in the inguinal folds, deep, with a fibrinous base. (c) Hypopigmented scars in the inguinal folds 4 months laterFigure 2: H and E. 4X. Irregular acanthosis in the epidermis, with a polymorphonuclear inflammatory infiltrate in the deep dermis extending to the hypodermis. There are areas of necrosis and haemorrhage with the formation of microabscessesFigure 3: H and E. 20X. Neutrophils in the deep dermisPyoderma gangrenosum is a non-infectious inflammatory dermatosis characterised by painful, undermined ulcers with defined borders, which can appear in various anatomical locations following minimal trauma (pathergy phenomenon). Its incidence is