Nail the diagnosis: Lamivudine-induced periungual pyogenic granulomas in PLHIV
Background: Pyogenic granuloma (PG), also known as lobular capillary haemangioma, is a benign vascular proliferation that typically presents as friable, red, pedunculated papules on the skin or mucous membranes. Multiple periungual pyogenic granulomas, a unique entity within cutaneous pyogenic granu...
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Elsevier
2025-01-01
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| author | Karthick Kumar Vaitheeswaran Neeraj Nischal Neetu Bhari Sudheer Kumar Arava Naveet Wig |
| author_facet | Karthick Kumar Vaitheeswaran Neeraj Nischal Neetu Bhari Sudheer Kumar Arava Naveet Wig |
| author_sort | Karthick Kumar Vaitheeswaran |
| collection | DOAJ |
| description | Background: Pyogenic granuloma (PG), also known as lobular capillary haemangioma, is a benign vascular proliferation that typically presents as friable, red, pedunculated papules on the skin or mucous membranes. Multiple periungual pyogenic granulomas, a unique entity within cutaneous pyogenic granulomas, most frequently occur in association with medications, including antiretroviral drugs. Clinical case: A 30-year-old male living with HIV presented with painful, progressively enlarging ulcero-proliferative lesions on the fingertips and toes, occurring 12 months after initiating highly active antiretroviral therapy (HAART) comprising Tenofovir disoproxil (300 mg), Lamivudine (300 mg), and Dolutegravir (50 mg). Examination revealed haemorrhagic, friable granulation tissue over the nail folds and paronychial areas of multiple digits. Systemic examination was unremarkable. Differential diagnoses included drug-induced PG, bacillary angiomatosis, Kaposi sarcoma, and cutaneous angiosarcoma. A biopsy confirmed the diagnosis of PG. Bartonella serology and tissue polymerase chain reaction (PCR) were negative, ruling out bacillary angiomatosis. Histopathology showed no features suggestive of Kaposi sarcoma or angiosarcoma. Among ART agents, lamivudine and indinavir have been most frequently associated with periungual PGs. The patient showed minimal improvement with topical corticosteroids, antibiotics, and debridement. Lamivudine was subsequently discontinued and ART was modified, leading to near-complete resolution of lesions over six months—supporting a diagnosis of lamivudine-induced periungual PG. Conclusion: Periungual pyogenic granulomas can lead to significant discomfort and functional impairment. This case highlights the potential role of lamivudine as a causative agent and underscores the importance of ART modification in the effective management of drug-induced PG. |
| format | Article |
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| institution | DOAJ |
| issn | 2214-2509 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | IDCases |
| spelling | doaj-art-4c5a71c3226a4c3a8f12d2adb9c78e9b2025-08-20T03:11:04ZengElsevierIDCases2214-25092025-01-0140e0227010.1016/j.idcr.2025.e02270Nail the diagnosis: Lamivudine-induced periungual pyogenic granulomas in PLHIVKarthick Kumar Vaitheeswaran0Neeraj Nischal1Neetu Bhari2Sudheer Kumar Arava3Naveet Wig4Department of Medicine, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of Medicine, All India Institute of Medical Sciences, New Delhi, India; Correspondence to: Department of Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of Pathology, All India Institute of Medical Sciences, New Delhi, IndiaDepartment of Medicine, All India Institute of Medical Sciences, New Delhi, IndiaBackground: Pyogenic granuloma (PG), also known as lobular capillary haemangioma, is a benign vascular proliferation that typically presents as friable, red, pedunculated papules on the skin or mucous membranes. Multiple periungual pyogenic granulomas, a unique entity within cutaneous pyogenic granulomas, most frequently occur in association with medications, including antiretroviral drugs. Clinical case: A 30-year-old male living with HIV presented with painful, progressively enlarging ulcero-proliferative lesions on the fingertips and toes, occurring 12 months after initiating highly active antiretroviral therapy (HAART) comprising Tenofovir disoproxil (300 mg), Lamivudine (300 mg), and Dolutegravir (50 mg). Examination revealed haemorrhagic, friable granulation tissue over the nail folds and paronychial areas of multiple digits. Systemic examination was unremarkable. Differential diagnoses included drug-induced PG, bacillary angiomatosis, Kaposi sarcoma, and cutaneous angiosarcoma. A biopsy confirmed the diagnosis of PG. Bartonella serology and tissue polymerase chain reaction (PCR) were negative, ruling out bacillary angiomatosis. Histopathology showed no features suggestive of Kaposi sarcoma or angiosarcoma. Among ART agents, lamivudine and indinavir have been most frequently associated with periungual PGs. The patient showed minimal improvement with topical corticosteroids, antibiotics, and debridement. Lamivudine was subsequently discontinued and ART was modified, leading to near-complete resolution of lesions over six months—supporting a diagnosis of lamivudine-induced periungual PG. Conclusion: Periungual pyogenic granulomas can lead to significant discomfort and functional impairment. This case highlights the potential role of lamivudine as a causative agent and underscores the importance of ART modification in the effective management of drug-induced PG.http://www.sciencedirect.com/science/article/pii/S221425092500126XLamivudinePyogenic granulomaParonychiaLobular capillary hemangiomaPLHIVART |
| spellingShingle | Karthick Kumar Vaitheeswaran Neeraj Nischal Neetu Bhari Sudheer Kumar Arava Naveet Wig Nail the diagnosis: Lamivudine-induced periungual pyogenic granulomas in PLHIV IDCases Lamivudine Pyogenic granuloma Paronychia Lobular capillary hemangioma PLHIV ART |
| title | Nail the diagnosis: Lamivudine-induced periungual pyogenic granulomas in PLHIV |
| title_full | Nail the diagnosis: Lamivudine-induced periungual pyogenic granulomas in PLHIV |
| title_fullStr | Nail the diagnosis: Lamivudine-induced periungual pyogenic granulomas in PLHIV |
| title_full_unstemmed | Nail the diagnosis: Lamivudine-induced periungual pyogenic granulomas in PLHIV |
| title_short | Nail the diagnosis: Lamivudine-induced periungual pyogenic granulomas in PLHIV |
| title_sort | nail the diagnosis lamivudine induced periungual pyogenic granulomas in plhiv |
| topic | Lamivudine Pyogenic granuloma Paronychia Lobular capillary hemangioma PLHIV ART |
| url | http://www.sciencedirect.com/science/article/pii/S221425092500126X |
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