Paraneoplastic acrokeratosis in a man living with HIV

Resumen

BACKGROUND: Paraneoplastic acrokeratosis is an acquired paraneoplastic disease characterized by psoriasiform lesions with acral predominance. It was first reported by Bazex in 1965 and is generally associated with aerodigestive squamous cell carcinoma. We present the first published case in a man living with HIV.

CLINICAL CASE: A 52-year-old male patient presented with growth of the right facial mass of approximately 4 months of evolution that radiated to the ear, cheek and jaw. A 10 x 7 cm in size multilobed exophytic neoformation was found in the neck. Asymptomatic, focal, hyperkeratotic infiltrative plaques were found on the palms of both hands and symmetric onychodystrophy in all the toenails. The HIV viral load was 861,993 copies/mL, the CD4 cell count was of 416 cells/µL (19%), and the CD8 cell count was of 1289 cells/µL (60%). A subsequent incisional biopsy showed infiltration by plasmablastic lymphoma. A chemotherapy regimen of bortezomib, etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (V-EPOCH) was started and HIV treatment was changed to bictegravir, emtricitabine, and tenofovir alafenamide.

CONCLUSIONS: Paraneoplastic acrokeratosis or Bazex generally affects male patients and is generally associated with head, neck and lung malignancies. Treatment of the underlying cause is the best therapeutic approach.

KEYWORDS: Bazex syndrome; Plasmablastic lymphoma; HIV.