Faculty Bibliography

Cutaneous photosensitivity in a 43-year-old man with idiopathic sideroblastic anemia associated with an abnormal porphyrin profile is reported. This condition was associated with elevated free erythrocyte porphyrin, plasma protoporphyrin, urine porphyrins (predominantly coproporphyrin), stool porphyrins (predominantly protoporphyrin), decreased ferrochelatase activity, and deletion of portions of the long arms of chromosomes 18 and 20. Five other patients with sideroblastic anemia and abnormal porphyrin profiles have been described; all but one of these patients had photosensitivity. The porphyrin profile of this patient is similar to that of three other previously described patients

A case of Acanthamoeba infection with cutaneous manifestations in a man seropositive for human immunodeficiency virus is reported. The diagnosis was made by identification of amoebic trophozoites and cysts in tissue specimens. Two other cases of disseminated Acanthamoeba infection with similar skin findings in patients with acquired immunodeficiency syndrome have been previously reported. Recognition of the cutaneous manifestations of acanthamoebiasis in patients seropositive for human immunodeficiency virus may lead to earlier diagnosis and improved therapy.

Five patients infected with the human immunodeficiency virus (HIV) with unusual manifestations of syphilis are reported. The high prevalence of HIV seropositivity among our patients with syphilis, the rapid progression to tertiary disease, the increased severity of the clinical manifestations, inappropriate antibody responses to infection, relapse without reexposure despite "adequate" treatment, and lack of response to penicillin therapy have been observed in these and in other patients. Data are presented to explain these unusual observations.

Twelve patients with photodermatitis for longer than 3 months' duration were identified: 1 patient with chronic photocontact dermatitis, 1 with persistent photosensitivity following exposure to a systemic medication, 6 with persistent light reactivity, and 4 with actinic reticuloid. There were 10 men and 2 women, ranging in age from 27 to 81 years, with a mean age of 62 years. The duration of the eruption ranged from 6 months to 20 years. Persistence of photosensitivity to quinidine, which is analogous to persistent light reactivity, was documented in 1 patient, and evolution from photocontact dermatitis to actinic reticuloid was observed in 2 others. These data, along with those reported in the literature, indicate that chronic photocontact dermatitis, persistent photosensitivity to systemic agents, persistent light reactivity, photosensitive eczema, and actinic reticuloid should be considered as entities occurring along a continuum, and the term 'chronic actinic dermatitis' is suggested to refer to these entities. Eight (67%) of the 12 patients had skin type VI and 2 others (17%) had skin type V, percentages markedly higher than those of the general patient population, demonstrating that chronic actinic dermatitis is not uncommon among individuals with dark skin