As more patients with human immunodeficiency virus (HIV) are surviving, despite severe immune suppression, clinicians are faced with atypical manifestations of both common and uncommon dermatoses. We report two boys aged three and half, and three years with CCSK, one of whom had a disease free survival of four years and eight months. Biopsies from rabbit retinas infected with herpes simplex virus, epiretinal membranes from patients with macular pucker, and retinas from patients with acute retinal necrosis were studied. Immunohistology on a lymph node biopsy showed a T-helper cell (CD4) infiltrate expressing the interleukin (IL)-2 receptor alpha and beta chains. I was concerned about a population of large atypical appearing lymphocytes in the superficial dermis and the immunohistochemistry studies showed that this population of cells stained with CD30 with a background of smaller CD3 positive T-cells. Some areas looked granuloma annulare-like, although without increased mucin. Special stains were negative for fungal and acid fast organisms and I did not identify herpes viral cytopathic changes.
Mycophenolate mofetil is a novel immunosuppressive agent developed for solid organ transplantation that prevents purine synthesis in circulating T and B cells, resulting in selective inhibition of clonal expansion. The majority of the patients were between 60 and 80 years of age. Gammaglobulin was given only when NNIs recurred. We examined sex, age, histology, type of rituximab-chemotherapy (fludarabine + rituximab versus other chemotherapy + rituximab) for correlation with NNI. Findings of both normal conjunctiva and sclera, examined using histology and immunohistochemistry, are reported here.