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Dermclinic 

Skin Lesions in an HIV-Positive Man

By Ted Rosen, MD | October 20, 2011
Dr Rosen is Professor of Dermatology at Baylor College of Medicine and Chief of the Dermatology Service at the Veterans Affairs Medical Center, both in Houston, Texas.

click here for larger imageA 38-year-old openly homosexual man presented with cough and multiple asymptomatic skin lesions on his face. A chest radiograph was positive for nodular parenchymal infiltrates, most consistent with an infection from either acid-fast bacilli or fungi. The patient refused bronchoscopy, and his cough was not productive enough to obtain a reliable sputum specimen for culture.

Physical examination disclosed many small, flesh-colored, umbilicated papules. Although he did allow a skin biopsy, he subsequently refused therapy and left the hospital against medical advice. He was lost to further follow-up.

Hospital admission screening labs revealed a positive HIV serology and gross lymphopenia on CBC. What do you think his skin lesions represent?

(Answer on next page)

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