Photo Quiz

Fever and Rash in a Patient with HIV Infection


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Am Fam Physician. 2016 Oct 15;94(8):658-660.

A 28-year-old man with a history of human immunodeficiency virus (HIV) infection and AIDS presented to the emergency department with fever and a widespread, severely painful, pruritic rash. The cutaneous eruption began on his chest and rapidly spread to his face, left lower eyelid, neck, trunk, genitalia, and upper and lower extremities. His CD4 cell count was 6 per mm3 (0.01 × 109 per L) with a viral load of 768,970 copies per mL. He was not compliant with highly active antiretroviral therapy. His white blood cell count, liver function, and kidney function were normal. He reported having chickenpox as a child.

On examination, he had vesicles and pustules, some umbilicated, overlying an erythematous base in a generalized distribution (Figure 1). His skin was tender, but the mucosal surfaces were unaffected. Ophthalmologic evaluation revealed no intraocular involvement.

Figure 1.


Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Cutaneous Mycobacterium avium-intracellulare complex infection.

B. Disseminated cryptococcosis.

C. Disseminated herpes simplex virus infection.

D. Disseminated varicella-zoster virus infection.

E. Secondary syphilis.

Author disclosure: No relevant financial affiliations.

Address correspondence to Ari Konheim, MD, at Reprints are not available from the authors.


show all references

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4. Endly DC, Ackerman LS. Disseminated cutaneous mycobacterium avium complex in a person with AIDS. Dermatol Online J. 2014;20(5):22616.

5. Bennett JE, Dolin R, Douglas RG, Mandell GL, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pa.: Elsevier/Saunders; 2015:2934–2948.e5.

6. Fancher W, Marsch A, Landers J, Scribner J. Disseminated herpes simplex virus presenting as crusted papules on the palms and soles of an immunosuppressed patient. Dermatol Online J. 2014;20(9).

7. Watts PJ, Greenberg HL, Khachemoune A. Unusual primary syphilis. Int J Dermatol. 2016;557):714–728.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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