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Nodular Cutaneous Microsporidiosis in a Patient with AIDS and Successful Treatment with Long-Term Oral Clindamycin Therapy

Kent E. Kester, MD; George W. Turiansky, MD; and Peter L. McEvoy, MD
[+] Article and Author Information

From Walter Reed Army Institute of Research, Walter Reed Army Medical Center, and Armed Forces Institute of Pathology, Washington, D.C. For current author addresses, see end of text. Acknowledgments: The authors thank Elaine Ellis, Department of Pathology, Walter Reed Army Medical Center, for electron microscopy and Dr. Charles N. Oster, Infectious Disease Service, Walter Reed Army Medical Center, for valued advice and encouragement. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Department of the Army or the Department of Defense. Requests for Reprints: Kent E. Kester, MD, Department of Immunology, Walter Reed Army Institute of Research, Washington, DC 20307-5100; e-mail, kesterk@wrsmtp-ccmail.army.mil.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;128(11):911-914. doi:10.7326/0003-4819-128-11-199806010-00009
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Background: In AIDS, nodular skin disease can result from various causes.

Objective: To report a new manifestation of microsporidial infection presenting as nodular skin disease with underlying osteomyelitis.

Design: Case report.

Setting: Tertiary-care military medical center in Washington, D.C.

Patient: A 36-year-old woman with late-stage AIDS who presented with disseminated, nodular cutaneous lesions and underlying osteomyelitis.

Measurements: Disseminated microsporidial infection with an Encephalitozoon-like species was diagnosed by electron microscopic examination of material obtained from the skin lesions.

Intervention: The patient received long-term oral clindamycin therapy, which cured her disseminated infection.

Conclusions: Microsporidia can cause disseminated cutaneous infections in AIDS patients. The response of this patient to long-term clindamycin therapy merits further evaluation.

Figures

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Figure 1.
Recurrent erythematous nodules with necrotic centers on lower legs.
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Figure 2.
Top.Bottom.

Gram stain of nodule aspirate. Many beaded, gram-positive organisms are present. Transmission electron micrograph of skin aspirate. Two microsporidia are visible in a portion of the aspirated material. Both have obvious clear external spaces corresponding to a chitinous coat. The circular coils of the polar tubules can be seen in each organism. Other sections showed similar organisms throughout the aspirated material (original magnification, x40 000).

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