February/March 2000

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A. B.



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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