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JAMA Dermatology Clinicopathological Challenge
December 2015

Persistent, Nontender Lip Swelling in a Patient With HIV

Author Affiliations
  • 1School of Medicine, University of Kansas Medical Center, Kansas City
  • 2Division of Dermatology, University of Kansas Medical Center, Kansas City
  • 3The Christ Hospital, Cincinnati, Ohio
JAMA Dermatol. 2015;151(12):1369-1370. doi:10.1001/jamadermatol.2015.2788

A man in his early 40s with a medical history significant for verruca vulgaris, dyshidrotic eczema, and human immunodeficiency virus (HIV) diagnosed 1 year prior to presentation reported a chief complaint of dry, swollen lips. The patient reported a 1-month history of “puffy and bumpy” lips. He also described his lower lip as sometimes becoming “dry and scaly” during this time but denied any bleeding from the area. On physical examination, there were several erythematous papules at the vermillion border of the lower lip within a background of edema (Figure, A and B). In addition, the patient had slight fissuring of the tongue, but the remainder of the oral mucosa was normal and intact. Findings of a complete review of systems were unremarkable, other than occasional headaches. The patient denied fevers, night sweats, abdominal pain, neurologic symptoms, chest pain, cough, and shortness of breath. He disclosed full compliance with his HIV highly active antiretroviral therapy (HAART), which included ritonavir, darunavir, etravirine, and raltegravir. He also reported taking sumatriptan as needed for headaches. Numerous laboratory tests were performed, including a complete blood cell count, complete metabolic panel, CD4 count, HIV viral load, and assays for C-reactive protein, erythrocyte sedimentation rate, angiotensin-converting enzyme, and rapid plasma reagin; all results were normal except for a slightly elevated angiotensin converting enzyme level (84 µg/L; normal, 9-67 µg/L). His CD4 count was within normal limits (520 cells/µL) and HIV viral load was undetectable. A biopsy was performed on the right lower lip (Figure, C and D).

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