A 45-year-old homosexual man presented with a painless papular eruption on his neck. He also complained of fevers, night sweats, and abdominal pain with vomiting. He was recovering from an eruption of herpes zoster on his chest but otherwise denied any medical problems and was taking no medications.
Physical examination revealed scattered, partially blanchable, 4- to 6-mm papules on the neck (Figure 1). The patient was seropositive for human immunodeficiency virus (HIV) infection by enzyme-linked immunosorbent assay testing, with Western blot confirmation. His viral load was greater than 750 000 copies/mL, with a CD4 cell count of 45/mm3 (reference range, 298-2045/mm3). A plain film of the abdomen showed small-bowel dilatation consistent with a partial bowel obstruction. Follow-up computed tomographic scanning of the abdomen revealed ileal thickening with retroperitoneal lymphadenopathy. A biopsy specimen was obtained from a papule on the neck (Figure 2 and Figure 3).
Swick BL, Walling HW. Papular Eruption in an HIV-Infected Man—Quiz Case. Arch Dermatol. 2007;143(2):255-260. doi:10.1001/archderm.143.2.255-b