A 55 y.o. male with untreated HIV presents with a skin rash

What do you think this represents?

Our patient had MRSA abscesses which can be “exuberant” in the HIV patient.  He had two abscesses which were covered with eschar and contained centrally necrotic fluid. On CT the fluid collections could be seen posteriorly.

SKIN LESIONS IN HIV

INFLAMMATORY- xerosis, atopic dermatitis, seborrheic dermatitis and prurigo nodularis all occur in HIV.

FUNGAL- Cryptococcus and candida can cause skin infections. Blastomycosis may have a similar appearance.

cryptococcal skin infection

INFECTIOUS-fall into several broad groups including viral :shingles, warts,  and molluscum (caused by a pox virus) and bacterial.  Bacterial infections include mycobacterial infections, MRSA and syphilis.

molluscum

CARCINOMA- Kaposi’s, squamous cell, basal cell have a higher incidence in HIV patients. Buschke-Lowenstein giant condyloma acuminatum are aggressive lesions which may transform to squamous cell carcinoma.

Buschke-Lowenstein giant anal codyloma with malignant tranformation.

Our patient went to the OR to have debridement of his abscesses.  The result appears below.

Franco-Paredes C, Marcos L, Henao-Martinez A, et al. cutaneous Mycobacterial Infection. Clinical Microbiology Reviews  DOI:10.1128/CMR.0069-18

Chamy J, Rady P, Tyring S, et al.  Malignant degeneration of diffuse intertriginous flat warts in a person with AIDS. JAAD Case Rep 2018 Jul; 4 (6):562-564.

Safi F, Bekdache O, Al-Salam S. et al. Giant condyloma acuminatum of Buschke-Lowenstein tumour: disease development between 2000 and 2010. Surg Practice 2014:18(1):27-36.