June/July 2007

Fig.1

HISTORY:
A 47 year-old African-American male with end stage AIDS and disseminated mycobacterium avium complex infection presented to the infectious disease clinic with lethargy and poor appetite. He was found to be tachycardic with a blood pressure of 80/60.

The patient had a history of noncompliance with prescribed medical treatments and his most recent CD4 count was less than 20 with a viral load of 200,000, off HAART therapy. The patient was hospitalized for severe dehydration and responded well to fluid hydration. Dermatology was consulted for a three month history of friable, verrucous, ulcerative lesions on the patient's chin.

PMHx:
HIV/AIDS diagnosed 1984 with viral load 10/06 >200,000 and CD4 count <20.
CMV retinitis 1996
Hepatitis A and B
Hypertension

Allergies: The patient denies any known drug allergies.

Social History: The patient has smoked _ pack per day for 33 years, denies alcohol or illicit drug use and lives with his mother.

PHYSICAL EXAMINATION:
T: 35.5, BP: 96/72, Pulse: 118, RR: 22
Friable, verrucous, ulcerated plaques on the chin. The remainder of the skin exam was unremarkable. No lymphadenopathy.

ADMISSION LABORATORY AND RADIOGRAPHY:
WBC: 3.5
Hemoglobin/Hematocrit: 10.2/30
Platelet count: 193,000
BMP, Coagulation Profile, LFTs: wnl
Blood Cultures: no growth
Cytomegalovirus blood PCR: positive at 859,601 copies.
Serum Cryptococcal Antigen: negative

CXR: no evidence of infiltrates but subtle bulge in region of aortopulmonary window that was also noted on prior radiograph.

Two 4 mm punch biopsies obtained, one for H&E, one for tissue culture.

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