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A 33-year-old male with a previous history of AIDS on highly active antiretroviral therapy and major depression presented to the emergency room with complaints of a generalized rash that started approximately 6 months prior to presentation. He had a remote history of treated syphilis, was sexually active with men, and used condoms inconsistently. The rash initially started on his shoulders and back with later progression to his arms, face, abdomen, and lower extremities over the course of several weeks. The lesions were initially flat, erythematous, and highly pruritic. When he first sought medical attention, he was treated for bed bugs and given a course of topical steroids without improvement. During the month before his visit, the lesions became progressively worse, increasing in size with persistent pruritus and burning. Upon admission, his vital signs were normal, skin findings included multiple annular discoid-appearing plaques with erythematous scaly borders, and hyperpigmentation with atrophy over his face, chest, abdomen, back, and thighs (Figures 1 and 2). Lesions were also found on his scalp that resulted in alopecia. The rest of his physical exam was unremarkable.
Single large skin lesion at the time of evaluation seen on patient’s back.
Ulcerated skin lesions at the time of evaluation seen on patient’s left arm.
A complete work-up, including a complete blood count, comprehensive metabolic panel, CD4 count, and viral load, were obtained, and a skin biopsy was performed.
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