December 2010





History: A 44 y/o homeless white male with a history of HIV/AIDS (unknown CD4 count) was admitted to the medicine service with pancytopenia. The patient complained of a rash on his bilateral lower extremities.  The rash began 1 week prior and was asymptomatic.  Of note, the patient was also being treated by a dentist for chronic gingivitis. (Fig.2)

Past medical history: HIV/AIDS with unknown CD4 count, history of recent MAC infection, cachexia and wasting syndrome

Medications: azithromycin, dronabinol, efavirenz/emtricitabine/tenofovir, ethambutol, rifabutin, phytovadione

Physical exam: Poor dentition with edematous, erythematous gingiva, including some areas of ulceration (Fig.1). Scattered 1-2 mm petechiae with multiple corckscrew hairs on the abdomen and bilateral lower extremities (Fig.2).

Labs: WBCs 0.9, Hgb: 9.3, Plt: 74, INR: 1.3


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