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History: The patient is a 32 year-old black female admitted to to the medicine service at Barnes/Jewish Hospital with a cough and facial lesions. The patient reported that she initially developed small "bumps" on her cheeks three weeks ago. Over time, these bumps had enlarged and coalesced; they also had become painful to the touch and drained a malodorous fluid. She denied fever, chills, mental status changes, anorexia, dizziness, dyspnea, or headache.
Her past medical history is significant for HIV/AIDS diagnosed in 1986.
A recent CD4 Count was 93, and a viral load was > 750,000. She currently
was not being treated with antiretrovirals secondary to side effects and
non-compliance. Related to her AIDS, she had previously been hospitalized
for multiple episodes of pneumocystis carinii pneumonia, two in which she
required intubation. She had a history of tuberculosis exposure and had
completed two courses of INK In 1989, she was diagnosed with 20 syphilis
and treated with benzathine penicillin x 3.
Physical Exam: At the bilateral malar eminence, the patient had
dome-shaped, skin-colored and purplish papules, some umbilicated, 2-3mm
in size. These coalesced into larger , confluent plaques with papules and
nodules (Figs. A., B. ). Areas of the plaques were excoriated and crusted.
The plaques and papules were tender to palpation.
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