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Skin Lesions in an HIV-Positive Man

Skin Lesions in an HIV-Positive Man

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A 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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