April 2016






History: A 30 year-old African American man with history of HIV infection presented with a 6 week history of “red bumps” on his skin.  He had a history of medication noncompliance and had not taken any antiretroviral therapy for at least 5 months.  The red bumps were not painful or pruritic.  He also endorsed subjective fevers and malaise. 


Past Medical History: HIV infection, noncompliance with HAART therapy.


Social History: Patient is homeless.  He smokes cigarettes and has a history of IV drug use.


Family History: Diabetes mellitus


Medications: None


Allergies: None


Physical Exam:  Cachectic, ill-appearing AAM with numerous red to violaceous papules on the chest, abdomen, upper and lower extremities (Figs.1and2). 


Laboratory Results:  Notable for hemoglobin of 4.5, CD4 count 10, HIV RNA of 42,300.  Histoplasma and cryptococcal antigens negative, CMV PCR negative, blood cultures negative.  Bartonella PCR positive.


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