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This article discusses the evaluation of routine molecular biology for the diagnosis of primary syphilis by assessing the serological status of patients with PCR-confirmed syphilitic ulcers. The study found that PCR analysis on lesions led to the diagnosis of primary syphilis in 64% of patients when serology was defective. This highlights the usefulness of PCR in detecting primary syphilis, especially in populations at risk of multiple reinfections or where follow-up is challenging. The article provides detailed clinical and epidemiological characteristics of patients with primary syphilis and emphasizes the importance of early detection for appropriate treatment and reducing transmission. [Extracted from the article]

SARS-CoV-2 vaccination is followed by cutaneous side effects in 2% of cases.[[1]] Some chronic dermatoses, more rarely oral lichen planus (LP), may be triggered or exacerbated after vaccination.[[1], [3], [5]] We report here 2 cases of multi-site mucosal LP that started after COVID-19 vaccination. SARS-CoV-2 vaccination may trigger and exacerbate mucosal lichen planus First, SARS-CoV-2 vaccination triggered LP although it is not possible to eliminate that LP was already present but quiescent before. [Extracted from the article]

Background: Kaposi sarcoma (KS) is a rare skin tumour caused by herpesvirus 8 infection and characterized by either indolence or an aggressive course necessitating systemic therapies. The genetic basis of this difference remains unknown. Objectives: To explore the tumour mutational burden in indolent and aggressive KS. Methods: We performed whole‐exome sequencing on a cohort of 21 KS patients. We compared genetic landscape including tumor mutational burden between the two forms of indolent and agressive KS. Results: Aggressive KS tumours had a significantly higher TMB and a larger cumulative number of deleterious mutations than indolent KS tumours. In addition, all aggressive tumours had at least three deleterious mutations, whereas most indolent tumours harboured only one or no predicted deleterious mutations. Deleterious mutations listed in the Cancer Gene Census were detected exclusively in patients with aggressive disease. An analysis of somatic copy‐number alterations (SCNA) revealed a tendency towards higher number of alterations in aggressive KS. Conclusions: These data suggest that SCNA alterations and an increase in mutational burden promote aggressive KS and that it might be more appropriate to consider indolent KS as an opportunistic skin disease rather than a cancer. [ABSTRACT FROM AUTHOR]

In one case, skin biopsy displayed a superficial and deep perivascular and perieccrine lymphocytic infiltrate similar to those of chilblains or chilblain-like lesions. Relapse or new skin manifestations occurred in 2 patients following the second dose without worsening of symptoms. Patient 2 presented with 2 erythematous nodules 4 days after the first dose and chilblains 5 days after the second dose without nodules relapse. [Extracted from the article]

Background: Syphilis is a sexually transmitted infection (STI) with a global prevalence estimated at 0.5% in 2012. Syphilis has been on the rise among men who have sex with men (MSM) in high‐income countries and remains at endemic levels in low‐ and middle‐income countries. This trend, however, has not been observed in Reunion Island. Objectives: To determine the prevalence, clinical characteristics and risk factors of syphilis in at‐risk patients visiting the South Reunion STI clinic in Reunion Island. Methods: This monocentric cross‐sectional study included all patients who visited our STI clinic between 2017 and 2020. Syphilis serology was performed on all included patients, and data were collected using a standardized self‐administered questionnaire. Results: Over the 3‐year study period, 2593 patients were enrolled. The prevalence of syphilis was 7.52% (n = 195, 95% CI, 6.50–8.65%) in the overall study population, 11.76% (n = 18, 95% CI, 6.97–18.59%) in minors (aged under 18 years) and 36.36% (n = 16, 95% CI, 21–59%) in pregnant women. The risk factors identified in multivariate analysis were being female [adjusted Prevalence Ratio (aPR) 1.85, 95% CI, 1.10–3.11], being MSM (aPR 2.87, 95% CI, 1.71–4.80), being aged under 18 years (aPR 3.54, 95% CI, 1.90–6.57), living in precarious conditions [aPR 3.12, 95% CI, 2.11–4.62] and being born in Reunion Island (aPR 2.43, 95% CI, 1.42–4.13). The clinical presentation was heterogeneous (plaques and papules, chancre, atypical ulcerations, multiple ulcerations, condyloma lata, etc.). Conclusions: These findings suggest a high prevalence of syphilis in at‐risk patients visiting our STI clinic. Unlike the situation in other high‐income countries, the people most at risk of syphilis in Reunion Island are local‐born residents, minors, women and precarious patients. This is a source of concern, especially given the risk of resurgence of congenital syphilis on the island. [ABSTRACT FROM AUTHOR]

The 2020 edition of the European guideline on the management of syphilis is an update of the 2014 edition. Main modifications and updates include: ‐The ongoing epidemics of early syphilis in Europe, particularly in men who have sex with men (MSM)‐The development of dual treponemal and non‐treponemal point‐of‐care (POC) tests‐The progress in non‐treponemal test (NTT) automatization‐The regular episodic shortage of benzathine penicillin G (BPG) in some European countries‐The exclusion of azithromycin as an alternative treatment at any stage of syphilis‐The pre‐exposure or immediate post‐exposure prophylaxis with doxycycline in populations at high risk of acquiring syphilis. [ABSTRACT FROM AUTHOR]

Editor Skin manifestations have been increasingly reported in the setting of COVID-19. We retrieved six series, including ours, in which the numbers of both infected patients and patients with skin signs were available.4,6,7,9,10 Cutaneous lesions were observed in 38 patients over 2199 COVID-19 cases. In patients with rashes, severity was found in 64% of cases and death in 2%, while it was respectively found in 5% and 0% patients with chilblains. [Extracted from the article]

Immune checkpoint inhibitors (ICI) nivolumab and pembrolizumab, antiprogrammed cell death protein 1 antibodies, and ipilimumab, an anti-cytotoxic T-lymphocyte-associated antigen 4 antibody, are widely used in metastatic melanoma. Median time from ICI initiation to encephalitis onset was 42 days (range: 5-640) and was longer in patients receiving pembrolizumab than in patients receiving combined nivolumab and ipilimumab. Patients displaying ICI-induced encephalitis presented with a non-specific pattern of encephalitis with focal symptoms, confusion, meningeal syndrome, with exclusion of infectious or carcinomatous meningitis or new brain metastasis. [Extracted from the article]

The secondary syphilis (SS) is usually characterized by cutaneous eruptions sometimes atypical associated with unspecific symptoms.1 Serology is normally highly positive and reliable in diagnosis of SS.2 However, some issues of serological diagnosis have already been reported previously in human immunodeficiency virus-infected (HIV) patients.3 Here, we present an uncommon case of SS in a 33-year-old man treated with Rituximab (RTX) (for multiple sclerosis with last injection in May 2019) whose treponemal test (TT) was initially non-reactive even though a typical rash was observed since more than 12 days before. Despite inconclusive serological assays for syphilis, we suggested SS and the patient received three injections of benzathine penicillin (2.4 million units intramuscular weekly) with a dramatic improvement after the first injection. Physicians caring for RTX recipients or severe immunocompromised patients should be aware that some patients may present symptoms of SS with initial negative serology. [Extracted from the article]

Background Classic Kaposi's sarcoma (CKS) occurs predominantly among elderly men and is associated with Kaposi's sarcoma-associated herpesvirus (KSHV). In low-endemic countries, KSHV infects predominantly men having sex with men (MSM). Objectives To describe a cohort of classic Kaposi sarcoma in a low-endemic area for KSHV, to highlight the features of CKS in MSM and identify prognostic factors. Methods Retrospective single-centre study of CKS cases. We compared MSM to heterosexual patients. Then, we divided the patients into two subgroups, those requiring a systemic treatment and the others, and we performed univariate and multivariate analyses to determine aggressiveness of CKS. Results Between 2006 and 2015, seventy-four patients were included. Mean age at diagnosis was 68.9 years; sex ratio (M/F) was 6.4, and 28% were MSM; MSM patients were younger (P = 0.02), less often originated from endemic areas (P < 0.0001). KS was less severe (P = 0.04), required more often a local treatment than a systemic one (P = 0.03). On multivariate analysis, CD4 T-cell count > 500/mm3 at baseline was associated with a reduced risk of severe evolution. Conclusion First CKS cohort in low-endemic zone. We describe a fifth subtype of KS: KS in MSM. The CD4 T-cell count was found to correlate with prognosis. [ABSTRACT FROM AUTHOR]

Mycobacterium avium-intracellulare complex ( MAC) infections are well known in immunocompromised patients, notably in human immunodeficiency virus infection, but remain scarcely described in kidney transplantation. Moreover, cutaneous involvement in this infection is very unusual. We describe here a disseminated infection caused by MAC in a kidney transplant recipient revealed by cutaneous lesions. This case highlights the need for an exhaustive, iterative microbiologic workup in the context of an atypical disease presentation in a renal transplant patient, regardless of the degree of immunosuppression. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Dermatological side-effects in hepatitis C infected patients under a triple regimen associating pegylated interferon, ribavirin and telaprevir," in the previous issue.

Background: The optimal management of Mycobacterium chelonae disease in immunocompromised patients remains unclear. A combination of antimicrobial agents is recommended as monotherapy with clarithromycin has been associated with clinical failures due to acquired resistance. Objectives: We aim to report the efficacy and tolerability of linezolid in association with clarithromycin for the treatment of M. chelonae infections in immunocompromised patients. Methods: We describe four immunocompromised patients treated by linezolid and clarithromycin for cutaneous M. chelonae disease. Results: This combination was associated with rapid clinical efficacy in all patients with no relapse observed after a median follow-up of 2.25 years (1.4 years). However, this treatment was responsible for frequent adverse events including thrombocytopaenia, myalgia and mitochondrial toxicity. All adverse effects were reversible after linezolid discontinuation. Conclusions: We therefore suggest linezolid/clarithromycin combination as the initial therapeutic strategy for M. chelonae skin infections in immunocompromised patients. [ABSTRACT FROM AUTHOR]

Background Syphilis remains a major public health problem in Europe (both in Eastern Europe since the 1990's and in Western Europe since the re-emergence of the disease in the late 1990's-early 2000's). Methods This guideline is an update of the IUSTI: 2008 European guideline on the management of syphilis and is produced by the European Guideline Editorial Board () and EDF Guideline Committee. Results It provides recommendations concerning the diagnosis and management of syphilis in Europe. Major advances include (1) broader use of PCR, immunohistochemistry, subtyping of the etiological agent Treponema pallidum subspecies pallidum, new treponemal tests, and rapid-point-of-care ( POC) tests detecting both treponemal and non-treponemal antibodies, (2) more flexible options for screening ( TT- treponemal test- first or NTT - non treponemal test- first or both TT and NTT), and (3) procaine penicillin is no longer the first line therapy option in any phase of the disease, i.e. long acting penicillin G (i.e. benzathine penicillin G- BPG) is the only first line therapy regimen in early syphilis and in late latent syphilis. Conclusions Syphilis is a disease that is relatively easy to detect by appropriate serological tests, however, all laboratory results should be considered together with clinical data and sexual risk anamnesis. Syphilis is also easy to treat with BPG. A major concern about the supply of BPG in many European countries could threaten the efficacy of the policies of eradication of the disease in Europe. [ABSTRACT FROM AUTHOR]

Background Merkel cell polyomavirus has been recognized to be associated with Merkel cell carcinoma ( MCC), but the evolution of this cancer probably depends on various factors. Vitamin D deficiency, defined by serum 25-hydroxyvitamin D levels <50 nmol/L, seems to influence cancer behavior and progression, but has never been assessed in MCC patients. Objectives First, to evaluate whether vitamin D deficiency was associated with tumor characteristics and prognosis in a cohort of MCC patients. Second, to assess expression of the vitamin D receptor ( VDR) in MCC tumors. Methods Clinical findings, Merkel cell polyomavirus markers and vitamin D status were assessed in a cohort of French MCC patients. The study was limited to the 89 patients for whom the serum sample had been collected within 3 years after the diagnosis of MCC. Correlation between vitamin D deficiency and MCC characteristics and outcome were determined in regression analyses. VDR expression in MCC tumours was assessed by immunohistochemistry. Results Vitamin D deficiency was noted in 65.1% of the patients and was independently associated with greater tumor size at diagnosis ( P = 0.006) and with metastasis recurrence ( HR, 2.89; 95% CI, 1.03 to 8.13; P = 0.043), but not with death from MCC, although there was a trend ( HR, 5.28; 95% CI, 0.75 to 36.96; P = 0.093). VDR was found to be strongly expressed in all 28 MCC tumor specimens investigated. Conclusion The association between vitamin D deficiency and MCC characteristics and outcome, together with detection of the VDR in MCC cells, suggest that vitamin D could influence the biology of MCC. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented that discusses development of classical Kaposi sarcoma through anti-hypertensive renin-angiotensin system inhibitors.

The article presents a case study of a 38 year old woman who received Subcutaneous (SC) injection of Bortezomib for multiple myeloma (MM). Topics discussed include histology showing fibrinoid necrosis of capillaries with thrombosis, presence of eccrine ischaemia compatible with diagnosis of Nicolau vasculitis and Bortezomib being reintroduced intravenously with no signs of relapse after skin was completely healed.

A letter to the editor offering information on the testing for levamisole and diagnosis of levamisole-related panniculitis is presented.

Background Quinolone-resistant Neisseria gonorrhoeae (QRNG) rates are increasing worldwide. Objectives (i) To assess the rate of QRNG among patients referred to a venereology clinic in Paris between 2000 and 2004; and (ii) to assess associated epidemiological factors. Methods Retrospective study of consecutive cases over 2000–2004. Indications and techniques of swabbing and culture were constant over 2000–2004. Susceptibility of N. gonorrhoeae was tested to six antibiotics: ciprofloxacin, amoxicillin, cefotaxime, tetracycline, erythromycin, and spectinomycin. Epidemiological data and anatomical site of N. gonorrhoeae infection were collected. Results Annual numbers of cases decreased ( P < 10−4) from 2000 ( n = 41) to 2002 ( n = 12), then increased ( P < 10−4) in 2004 ( n = 60). Anorectal gonorrhoea was more frequent in 2003–2004 (22.0%, n = 18/82) than in 2000–2002 (3.9%, n = 3/76). QRNG rates increased from the period 2000–2002 (1.3%) to 2003 (22.7%, P < 0.01), and 2004 (30.2%, P < 0.005). All QRNG strains had a minimal inhibitory concentration of ciprofloxacin > 1.0 mg/L, thus fitting the international definition of quinolone resistance. There were no significant changes in rates of N. gonorrhoeae resistance to the five other antibiotics. QRNG tended to be more frequent among men who have sex with men (MSM; 16.7% vs. 7.1%), HIV-infected patient (20.5% vs. 11.9%), and patients having more than five partners during the last year (24.4% vs. 17.1%), but statistical significance was not reached in multivariate analyses. Conclusion We recommend (i) avoiding fluoroquinolones as first-line treatment for N. gonorrhoeae infections in Paris; (ii) that first-line treatment relies on third-generation cephalosporins or spectinomycin; and (iii) reinforcing targeted screening and prevention of gonorrhoea, especially among HIV-positive patients and MSM. [ABSTRACT FROM AUTHOR]

To study the possible influence of patient characteristics on abacavir pharmacokinetics.A population pharmacokinetic model for abacavir was developed using data from 188 adult patients by the use of a nonlinear mixed effects modelling method performed with NONMEM.Abacavir pharmacokinetics was well described by a two-compartment open model with linear absorption and elimination. Typical population estimates for the absorption rate constant (Ka), the apparent central distribution volume (Vc/F), the apparent peripheral distribution volume (Vp/F), the apparent intercompartmental clearance (Q/F) and the apparent plasma clearance (CL/F) were 1.8 h−1, 75 l, 23.6 l, 10 l h−1 and 47.5 l h−1, respectively. Apparent plasma clearance was positively related to bodyweight. Individual Bayesian estimates of CL/F were used to calculate abacavir AUC. The latter decreased from 10.7 ± 5.0 to 5.7 ± 1.6 mgh l−1 when bodyweight increased from 36 to 102 kg. This drop in abacavir exposure could lead to suboptimal treatment for the heaviest patients, as antiviral efficacy of abacavir is known to be related to its AUC. A 400 mg abacavir dose would be necessary to achieve adequate exposure to abacavir in patients weighing more than 60 kg.The apparent plasma clearance of abacavir was positively related to bodyweight. The efficacy of the current recommended abacavir dosage for patients with high bodyweight should be evaluated in further studies. [ABSTRACT FROM AUTHOR]

Objectives Known for their ability to inhibit the human DNA polymerase-γ, nucleoside analogues induce toxic effects on mitochondria ranging from increased serum lactate levels to fatal lactic acidosis. DNA polymerase-γ ensures the mitochondrial DNA (mtDNA) replication and, thus, its inhibition leads to the decrease of the mtDNA. We describe a real-time PCR assay for mtDNA quantification associating DNA extraction procedures applied on peripheral blood mononuclear cells (PBMCs) and subcutaneous adipose tissues and to study the antiretroviral effect on mitochondria. Methods Total DNA was extracted from PBMCs and subcutaneous adipose tissues. Nuclear and mitochondrial genes were amplified to determine the number of copies of mtDNA per cell using a cyt-b recombinant plasmid as standard control. We analysed eight HIV-infected asymptomatic patients never treated, four patients who had been treated for 6 months with highly active antiretroviral therapy (HAART) and six non-infected donors. Results The mtDNA quantification gave rise to reproducible results as the mean coefficients of variation were 1.09% for replicates of samples undertaken 10 times within the same run, and 5.78% and 3.7% for replicates tested in five different runs at 1:100 and 1:1000 dilutions, respectively. Median levels of mtDNA in PBMCs of healthy donors, naive and treated HIV-infected patients were 2.94, 2.78 and 1.93 log HIV-1 RNA copies/mL, respectively. Whereas DNA from PBMCs was shown to be devoid of inhibitors, subcutaneous adipose tissues needed an extra treatment as they were found to be highly inhibited. Conclusions The method generated consistent and reproducible results and was successfully applied to DNAs extracted from PBMCs and subcutaneous adipose tissues with adapted extraction. The mtDNA changes in PBMCs were found to be fast as they fall off after 6 months' therapy, decreasing from 2.78 to 1.93 log copies/mL. [ABSTRACT FROM AUTHOR]

Discusses the treatment for scabies. Local treatments that are used to cure the disease; Drugs that are used for its treatment; Role of systemic ivermectin in onchocerosis treatment.

A thermodynamic database has been developed for NI-base superalloys. Following the CALPHAD procedure, it is based on the assessment of thermodynamic behaviour of the relevant constituting sub-systems of the complex system of interest. The current database contains 7 elements: Al, Co, Cr, Ni, Ti, W, Re. The thermodynamics of the y and y' phases are modelled with a single Gibbs energy function taking into account the crystallographic relation between these two phases. The formalism of the thermodynamic models used is briefly introduced. A few phase diagrams calculated with the current database in assessed binary and ternary systems are presented. Some experiments available in higher order systems are compared with the results of calculations with the current database. The ability of extrapolation of the database is verified for solid state equilibria as well as for solidification behaviour (liquidus temperature and partition ratios). The introduction of Mo and Ta to the current database is in progress. Other elements (Nb, Fe, Zr, Hf, C, B, ...) are planed to be introduced. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 24-year-old homosexual man hospitalized for cough, fever and headache. Topics discussed include initial diagnosis revealed cerebral toxoplasmosis and Pneumocystis jirovecii pneumonia, diagnosed with immune reconstitution inflammatory syndrome (IRIS) linked to syphilis in the setting of rapid increase in CD4, and not just syphilis due to which speed of apparition after the serology and atypical presentation with arthritis became positive.

A response from the authors of the article "European guideline on the management of syphilis" in the 2014 issue is presented.

7-11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK [ABSTRACT FROM AUTHOR]

The article presents a study which examines the outcome of granuloma annulare (GA) as well as the factors associated with shorter disease duration. The researchers in the study used the Kaplan-Meyer method and showed that the mean duration of GA is 5.9 years from the onset. Also, the skin lesions is shorter in patients with a recent onset of GA.

A letter to the editor on endometriosis associated with umbilical nodule is presented.

Background: Many assays are available on cerebrospinal fluid (CSF) for the diagnosis of neurosyphilis (NS) but there is no 'gold standard'., Objectives: The aim of this study was to evaluate different molecular and serological assays used in NS., Methods: We evaluated two PCR assays and three serological techniques in parallel on CSF samples collected between 2019 and 2020 from patients suspected of NS., Results: The study included 143 patients comprising 30 early NS, 7 late NS and 106 patients without a diagnosis of NS. All patients with NS were symptomatic and had either neurological (67.6%) or ophthalmological signs (54.1%). The qPCR and nPCR assays had overall sensitivities (Se) of 41% and 27%, respectively; with each an overall specificity (Sp) of 100%. VDRL had a Se of 51% and a Sp of 92%. Immunoblot had a Se of 62% and a Sp of 85%. Finally, treponemal tests (TT) had a Se of 96% and a Sp of 69%., Conclusions: Our study confirms the excellent specificity of molecular techniques allowing to avoid overdiagnosis of NS, and thus, unjustified intensive antibiotic therapy protocols. CSF TT, although not very specific, has an excellent Se confirming that there is almost never NS with negative CSF TT. VDRL and immunoblot tests have better overall diagnostic performance. However, none of these techniques has sufficient diagnostic performance to represent a 'gold standard'. Thus, the diagnosis of NS relies on a combination of clinical and biological parameters with the association of PCR with serology, associating VDRL and immunoblot, in CSF., (© 2022 European Academy of Dermatology and Venereology.)

Objective: In patients with systemic sclerosis (SSc), activated fibroblasts produce reactive oxygen species (ROS) that stimulate their proliferation and collagen synthesis. By analogy with tumor cells that undergo apoptosis upon cytotoxic treatment that increases ROS levels beyond a lethal threshold, we tested whether activated fibroblasts could be selectively killed by the cytotoxic molecule arsenic trioxide (As(2) O(3) ) in a murine model of SSc., Methods: SSc was induced in BALB/c mice by daily intradermal injections of HOCl. Mice were simultaneously treated with daily intraperitoneal injections of As(2) O(3) ., Results: As(2) O(3) limited dermal thickness and inhibited collagen deposition, as assessed by histologic examination and measurement of mouse skin and lung collagen contents. As(2) O(3) abrogated vascular damage, as shown by serum vascular cell adhesion molecule 1 level, and inhibited the production of autoantibodies, interleukin-4 (IL-4), and IL-13 by activated T cells. These beneficial effects were mediated through ROS generation that selectively killed activated fibroblasts containing low levels of glutathione., Conclusion: Our findings indicate that treatment with As(2) O(3) dramatically improves skin and lung fibrosis in a mouse model of SSc, providing a rationale for the evaluation of As(2) O(3) treatment in patients with SSc., (Copyright © 2012 by the American College of Rheumatology.)

Objective: Systemic sclerosis (SSc) is characterized by the fibrosis of various organs, vascular hyperreactivity, and immunologic dysregulation. Since Notch signaling is known to affect fibroblast homeostasis, angiogenesis, and lymphocyte development, we undertook this study to investigate the role of the Notch pathway in human and murine SSc., Methods: SSc was induced in BALB/c mice by subcutaneous injections of HOCl every day for 6 weeks. Notch activation was analyzed in tissues from mice with SSc and from patients with scleroderma. Mice with SSc were either treated or not treated with the γ-secretase inhibitor DAPT, a specific inhibitor of the Notch pathway, and the severity of the disease was evaluated., Results: As previously described, mice exposed to HOCl developed a diffuse cutaneous SSc with pulmonary fibrosis and anti-DNA topoisomerase I antibodies. The Notch pathway was hyperactivated in the skin, lung, fibroblasts, and splenocytes of diseased mice and in skin biopsy samples from patients with scleroderma. ADAM-17, a proteinase involved in Notch activation, was overexpressed in the skin of mice and patients in response to the local production of reactive oxygen species. In HOCl-injected mice, DAPT significantly reduced the development of skin and lung fibrosis, decreased skin fibroblast proliferation and ex vivo serum-induced endothelial H(2)O(2) production, and abrogated the production of anti-DNA topoisomerase I antibodies., Conclusion: Our results show the pivotal role of the ADAM-17/Notch pathway in SSc following activation by reactive oxygen species. The inhibition of this pathway may represent a new treatment of this life-threatening disease., (Copyright © 2010 by the American College of Rheumatology.)

We describe a 73-year-old HIV negative patient who presented with symptomatic hypoglycemia. Over the course of several months she was diagnosed with three human herpesvirus-8 related diseases: multicentric Castleman's disease, primary effusion lymphoma and Kaposi's sarcoma. No improvement was observed following cytotoxic therapy and she died 16 months after her initial presentation. The etiology of the hypoglycemia remained obscure over the course of this patient's disease. This case is the first report of a patient with three human herpesvirus-8 related diseases, and the first report of severe hypoglycemia as the presenting symptom of any of these diseases., (Copyright 2000 Wiley-Liss, Inc.)