Psoriasiform Hailey-Hailey Disease Presenting as Erythematous Psoriasiform Plaques Throughout the Body: A Case Report

摘要

The narrative of life that is revealed during illness and death exposes the fabric and shapes of the human spirit and the texture of human consciousness. The following three clinical encounters illustrate how tragedy, grief, and despair have no architecture: We collapse on cruel universal scars. There is, however, an unbroken flame that never flickers or goes out that brings harmony within the anarchic disequilibrium of human suffering.Case 1. The Imbalance of Health InequityK could not answer any of my questions. Her mother, standing at the bedside, informed me that K had a seizure that morning, which was why she brought her to the Emergency Department. K grew up in a rural town in the Deep South of the US. She was able to finish high school but because of economic hardship in her family she began working soon thereafter. K became a single mother of 3 children, now between the ages of 3 and 8 years. She was working 2 different jobs to support her children up until the day before her admission to the hospital. Three years ago, as part of her obstetric screening, she was found to be human immunodeficiency virus (HIV)-seropositive. Except when she received zidovudine intravenously before undergoing a caesarean section that prevented her daughter from becoming HIV infected, she has never received antiretroviral therapy. One year ago, K sought medical attention to initiate treatment with antiretroviral therapy. However, because of the nonnegotiable daily commitments of single motherhood, she could not afford the medication copay. K was 30 years old when I met her.K doesna??t live in desperate poverty, but she stands at the lower end of the social scale with important disadvantages that eventually led her to poor health. Poverty alone does not produce ill healtha??social inequality does. Unequal and unfair life opportunities are the result of long-term structural imbalances of social systems. Indeed, the distribution of health is directly related to life opportunities and reduced functional capabilities, including conditions of life that matter such as decent housing, adequate nutrition, social support, access to schools and adequate health care, and many other structural factors. Yet amid the increasing entropy of daily life and as the result of social inequities, life went on for K until her illness struck her ability to care for her children.K was suffering from intracranial hypertension secondary to cryptococcal meningoencephalitis as a manifestation of advanced HIV-associated immunosuppression. Every evening, after work, K would spend time with her children, assisting them in completing their homework and preparing dinner for them. Despite being a single mother of three and facing substantial financial constraints, she never applied for welfare support or requested food stamps support. Who would take care of her children if she died from this life-threatening fungal infection? And if she died, what were the chances of her children remaining trapped in this social vacuum? K was treated with antifungals and underwent placement of a lumbar drain to continuously release cerebrospinal fluid to reduce her intracranial pressure. After a prolonged hospitalization and rehabilitation process, as of this writing she is receiving daily antiretroviral therapy and remains on oral suppressive antifungal therapy. She has returned once again to helping her children complete their homework after school. She is living on food stamps; however, she is planning to return to work as soon as she recovers her strength. Because of her adherence to antiretroviral medications, her plasma level of HIV ribonucleic acid viral load is now undetectable. Her beautiful smile is the most reliable sign of her recovery.The narrative of health and illness is inexorably linked to societal factors. Unequal distribution of life chances leads to unequally distributed health outcomes.1 To understand why K became trapped in a position of social disadvantage, there is a need to understand larger societal factors: The immense inequities and vastly complex collective histories of the locations where individuals live and grow up have a direct link to our health outcomes.1 Inequality disempowered this single mother: She lacked opportunities to achieve control of her life. She did not have the financial means and social support to empower her to seek adequate medical care, to afford expensive medications, to improve her nutrition, and ultimately to have a prospect to transform her life outlook. She became vulnerable to acquiring HIV infection, and once she acquired this infection, a perpetual cycle of social injustices ensued. If K had succumbed to this fungal disease, chances are that the life-opportunities of her children would have been severely impacted. Adverse childhood experiences, including a poor socioeconomic environment2 when losing a parent, have important implications for adult life functioning. However, Ka??s children have continued to attend