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Atypical cutaneous lymphoproliferative
disorder (ACLD) is a rare condition that has been associated with HIV infection.
Patients with ACLD present with diffuse, erythematous and pruritic skin lesions
accompanied by generalized lymphadenopathy. The clinical characteristics of
ACLD overlap most notably with several other conditions including Mycosis
Fungoides/Sézary Syndrome (MF/SS), a cutaneous lymphoma of T-cell lineage.
Unlike Mycosis Fungoides, the noxious infiltrates of ACLD are not monoclonal
but polyclonal and consist of cytotoxic CD8+ T-cells instead of CD4+ T-cells or
B-cells. Highly active antiretroviral therapy (HAART) has been reported to
improve ACLD. We describe the case of a Caucasian man with longstanding HIV
infection who presented with severe erythroderma. Skin and lymph node biopsies
showed polyclonal CD8+ T-cell infiltrates. Gene rearrangement studies did not
reveal an obvious clonal disorder. Hallmark peripheral blood findings
consisting of a severe depletion of CD4+ T-lymphocytes and markedly elevated
CD8+ cells provided an important diagnostic clue. Despite the purported
benefits of HAART in ameliorating this disorder, erythroderma and extreme
pruritus improved only after the patient began taking mycophenolate mofetil and
hydroxyurea. Unfortunately, he succumbed to complications of
methicillin-resistant Staphylococcus aureus septicemia. We alert readers to
this rare HIV-associated condition which may mimic other benign and malignant
skin conditions and briefly discuss diagnostic and therapeutic options.
To evaluate the accuracy of cervical effacement reported as a percentage by
digital cervical exams using cervical length determined by transvaginal
ultrasonography as a standard. Methods: Records of pregnant women who had a
digital cervical exam and subsequent transvaginal ultrasound scan for cervical
length between January 2005 and December 2008 were reviewed. Digital cervical
exams were performed by different examiners. Transvaginal ultrasound was
performed by one examiner who did not perform any of the digital exams.
Cervical effacements were recorded as a percentage and cervical lengths were
measured in centimeters. Results: A total of 173 women met the study criteria.
Average cervical length for 0% effacement was 3.3 ± 1.1 cm (0.8 - 5.0 cm);
20% effacement, 1.6 ± 1.0 cm (0.9 - 3.0 cm); 25% effacement,
2.2 ± 0.2 cm (2.0 - 2.3 cm); 30% effacement, 2.6 ± 0.4 cm (2.1 - 3.0 cm); 40% effacement, 3.0 ± 0.4 cm (2.6 - 3.4
cm); 50% effacement, 2.4 ± 1.1
cm (0.6 - 4.6 cm);
60% effacement, 2.3 ± 1.4 cm (0.7 - 4.3 cm); 70%
effacement, 2.2 ± 0.8 cm (1.1 - 3.3 cm); 75%
effacement, 1.7 ± 1.4 cm (0.7 - 2.7 cm); 80% effacement,
2.0 ± 0.9 cm (0.6 - 4.4 cm); 90% effacement, 0.7 ± 0.4 cm (0.4 - 0.9 cm); 100% effacement, 1.2 ± 1.5 cm (0.3 - 3.0 cm).
The coefficient of variation ranges from 10% - 124%. Conclusion: The
traditional method of reporting cervical effacement as a percentage is
unacceptably inaccurate compared to the actual cervical length determined by
vaginal probe ultrasound.