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JAMA Clinical Challenge
August 3, 2021

Alopecia in a 36-Year-Old Man With HIV Infection

Author Affiliations
  • 1Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 2Divisions of Infectious Diseases and General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
JAMA. 2021;326(5):435-436. doi:10.1001/jama.2021.7082

A 36-year-old man presented to the emergency department with 3 weeks of generalized weakness and a dry cough. He reported hair loss for 1 month. Medical history was significant for opioid and alcohol use disorders, injection drug use, and chronic HIV infection. He discontinued his antiretroviral therapy 2 years prior to presentation. At that time, his CD4+ cell count was 820/μL and his HIV viral load was undetectable.

On presentation, his heart rate was 88/min and regular; blood pressure, 90/58 mm Hg; oxygen saturation, 100% on room air; and respiratory rate, 20/min. He was afebrile. Cardiorespiratory auscultation was deferred because a diagnosis of COVID-19 was considered. He had a faint maculopapular rash on his arms and torso and patchy hair loss on his scalp (Figure). There were no genital lesions or mucosal ulcerations.