Widespread papules in a patient with human immunodeficiency virus

Abstract

Conflict of interest: none declared. A 39‐year‐old man was referred in August 2007 with a 6‐month history of an asymptomatic, widespread rash that had appeared 3 days after starting prophylactic azithromycin for Mycobacterium avium intracellulare. He had been diagnosed with human immunodeficiency virus (HIV) type 1 in 1994, and at the time of presentation he was on highly active antiretroviral treatment (HAART) with tenofovir/emtricitabene (Truvada®; Gilead Sciences Ltd, Cambridge, UK) and lopinavir/ritonavir (Kaletra®; Abbott Laboratories Ltd, Maidenhead, Berkshire, UK) in addition to cotrimoxazole and aciclovir. He had advanced HIV disease with multidrug‐resistant virus. His CD4 count on presentation was 32 cells/mm3 and HIV viral load was < 456 × 103 copies/mL (5.63 logs). He had an IgA level of twice the normal level, with no evidence of immune paresis. On physical examination, an extensive papulonodular eruption was seen on the patient’s back, chest, neck, arms and face, with areas of excoriation (Fig. 1). In addition, there was a herpetic ulcer on his left pinna. A lesional skin biopsy was taken from the left arm.