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
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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