Usual vulval intraepithelial neoplasia in HIV-positive women - a case series

Usual or undifferentiated type vulval intraepithelial neoplasia (VIN) is more common in young women and is usually associated with high-risk human papillomavirus infection. It is associated with the development of basaloid or warty squamous cell carcinoma. Studies have shown that HIV-positive women have an increased risk of VIN and invasive vulval carcinoma, but there is a paucity of data about this cohort of women. The objective of this study was to describe the clinical features and treatment responses of HIV-positive women diagnosed with VIN in a specialist vulval dermatology clinic. HIV-positive women diagnosed with VIN from 2007 to 2013 were retrospectively identified. Data were collected on demographics, clinical features, treatments and outcomes. Seven cases were retrospectively identified. The median CD4 cell count at presentation was 500 cells/mm³ (range 59-761). Five had multifocal VIN. Five were treated with imiquimod alone, one had surgical excision and one patient was treated with imiquimod and surgery. Five of the seven had complete resolution of disease. HIV-positive patients with VIN had good responses to treatment with imiquimod. They were likely to be stable on combination antiretroviral therapy at presentation, have multifocal disease and concurrent vaginal, anal or cervical intraepithelial neoplasia.

Unmasking of progressive multifocal leukoencephalopathy in a patient with HIV-2

HIV-2 is common in West Africa but rarely found in developed countries. It usually has a milder disease course than HIV-1 and clinical presentations of neurological syndromes in HIV-2 are extremely rare. We report a case of a HIV-2-infected, 46-year-old woman originally from Cote d'Ivoire who presented with possible intracerebral toxoplasmosis infection then developed progressive multifocal leukoencephalopathy.

Calvarial syphilis in an HIV-positive man

Bone involvement in secondary and tertiary syphilis is a well-documented but unusual phenomenon. We report the case of an atypical presentation of secondary syphilis in a 25-year-old HIV-positive man who has sex with men. He presented initially with headaches and an unusual calvarial swelling. The skull findings were consistent with osteitis and he later developed systemic symptoms. Treponema pallidum serology was positive and the lesions and systemic symptoms resolved completely after administration of appropriate antibiotic therapy.

Screening for cognitive deficits in a sample of hospitalized geriatric patients: a re-evaluation of a brief mental status questionnaire

A 30-item screening examination for cognitive deficits was administered to 65 hospitalized elderly patients and to 60 elderly controls. A high proportion (73 per cent) of the hospitalized patients were found to have low cognitive scores indicative of probable organic mental syndrome (OMS). Especially high deficits were found among the patients with orthopedic and cerebrovascular conditions. The test correctly identified the 15 cases of established OMS. The percentage of false positive results in the normal controls was reasonably low. The importance of routine cognitive measurements in medical wards is stressed.