In a group of over 900 patients infected with human immunodeficiency virus type 1 (HIV-1) who underwent follow-up for cutaneous disease, we have seen 17 patients in whom evidence of thrombotic disease developed (Table). The majority of patients have presented with peripheral thrombophlebitis or strokes as their presenting thrombotic incident; however, we have seen two patients whose first sign of a hypercoagulable state was digital infarcts (Table) (Figure 1). The case reports of the two patients with cutaneous infarction illustrate this serious complication of HIV-1 infection.
Report of Cases.Case 1.
A 28-year-old HIV-1-positive Walter Reed stage 6 (last CD4 count, 0.09 × 109/L 1 year before) black man presented with acute onset of multiple digital infarcts of both upper extremities (Figure 1). The patient had had periodic low-grade fevers for over 4 months. Multiple blood cultures for bacteria, mycobacteria, and fungi were all negative. Coagulation studies included the following
Smith KJ, Skelton HG, Yeager J, Wagner KF. Cutaneous Thrombosis in Human Immunodeficiency Virus Type 1-Positive Patients and Cytomegalovirus Viremia. Arch Dermatol. 1995;131(3):357-358. doi:10.1001/archderm.1995.01690150123030