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Case 1: A 43-Year-Old with a Persistent Skin Rash

Authors: David H. Spach, MD
Roy Colven, MD

Last Updated: June 27, 2008

A 43-year-old HIV-infected man with advanced AIDS and a CD4 count of 22 cells/mm3 had the gradual development of a nonpruritic, diffuse, erythematous, macular rash. Initially, the rash was thought to be a drug eruption secondary to phenobarbital, but the condition steadily progressed for 2 weeks after discontinuing this medication. At that point, the rash had evolved into hyperkeratotic plaques on the thighs, chest, back, shoulders, and upper arms. Marked fissuring had also developed on the shoulder (Figure 1). The rash never became pruritic. Scale was collected by scraping and examined at low power under a microscope (Figure 2).

Which of the following is the most likely diagnosis of this patient’s skin problem?

A Psoriasis with secondary lice infestation.
B Seborrheic dermatitis.
C Secondary syphilis.
D Crusted scabies.
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    Figure 1 - Rash in Patient with Advanced AIDS Figure 1
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    Figure 2 - Microscopic View of Skin Scraping Figure 2