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Lower leg swelling with irregular brownish red spots/KS?
Sep 7, 2000

I am a 49 year old male with AIDS. I have been on all the current HAART combination with little success at bringing my viral load down and keeping it at a stable state. My viral load is 82,500 and my CD4 count is presently at 120.

I had notice a small brownish rash on my feet about two years ago. My doctor sent me for a skin biopsy that came back as erythema elevatum diutinum. I was told there was no treatment. Since that time I have developed large flat brownish red lesions on my lower legs more concentrated around my ankles and dorsal side of my feet including my toes. Some of these lesions have run together creating large brownish red spots that seem to be going together. My legs,lower ankles and feet are swollen most of the time. Lasix and elevation helps little. I now am treated by a infectious disease specialist that is going to send me to another dermatologist. He thinks this could be Kaposi. There is little information on erythema elevatum diutinum so I don't know if these are usual symptoms or if this is probably KS. I would appreciate some feedback. Tom

Response from Dr. Stryker

Any suspicious lesions of this type on the skin should be evaluated by a dermatologist, regularly. The fact that two years have elapsed since the last biopsy, and that new and maybe different lesions are now present, should prompt another biopsy.

KS can appear in unusual forms, and other (treatable) conditions can look like KS. KS should always be diagnosed by a biopsy, at least initially, for this reason. Subsequent similar-appearing spots can probably be treated without a biopsy every time. RAS

Rick Stryker, M.D., M.P.H.

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