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Generalized targetoid eruption in a man with HIV
Generalized targetoid eruption in a man with HIV Megan Morrison, DO,a Melba Estrella, MD,a Brian Schapiro, MD,b and Daniel Stewart, DOc Ann Arbor and Clinton Township, Michigan
A 36-year-old man with a long-standing history of HIV presented with a 1-month history of a generalized asymptomatic centrifugal skin eruption. He reported a new sexual partner over the past few months and a history of penicillin allergy. He denied any history of arthritis, herpes simplex infection, or new medications. The physical examination revealed scattered erythematous macules and annular patches on his scalp, chest, arms, palms, legs, and soles, with a few pustules and ulcerations on his groin (Figs 1 and 2). A punch biopsy specimen was obtained and was sent for review by the dermatopathologist (Figs 3 and 4). From the Departments of Dermatologya and Dermatopathology,b St Joseph Mercy Hospital, Ann Arbor, and the Midwest Center for Dermatology,c Clinton Township. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Melba Estrella, MD, 1529 Hawkeye, Rochester Hills, MI 48307. E-mail: [email protected].
J Am Acad Dermatol 2015;73:e131-2. 0190-9622/$36.00 ª 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.05.011
e131
e132 Morrison et al
1.
J AM ACAD DERMATOL
OCTOBER 2015
Based on the patient’s history and the photographs, what is the most likely diagnosis? A. Pityriasis rosea B. Erythema multiformeelike secondary syphilis C. Gonococcemia D. Rocky Mountain spotted fever E. Acute HIV exanthema
2.
What is the most appropriate treatment for this patient’s disease? A. Doxycycline 100 mg orally twice a day for 3 weeks B. Intramuscular benzathine penicillin 2.4 million units once weekly for 3 weeks C. Intramuscular benzathine penicillin 2.4 million units in a single dose D. Emollients and topical corticosteroids E. Prednisone tapered over 2 weeks
3.
What is the cause of this unique presentation? A. B. C.
Focal degeneration of collagen and elastic fibers and mucin deposition Immunologic defense against human herpesvirus-7 and -6 The endothelium is stimulated to produce toxic reactive oxygen species, and the infectious agent replicates within the endothelial cell until it bursts D. The infectious agent produces keratinases, which allow invasion into the stratum corneum E. Immune response against antigens of Treponema pallidum via the formation of immune complexes Please visit http://www.eblueimages.org to answer these questions.
A 36-year-old man with a long-standing history of HIV presented with a 1-month history of a generalized asymptomatic centrifugal skin eruption. He reported a new sexual partner over the past few months and a history of penicillin allergy. He denied any history of arthritis, herpes simplex infection, or new medications. The physical examination revealed scattered erythematous macules and annular patches on his scalp, chest, arms, palms, legs, and soles, with a few pustules and ulcerations on his groin (Figs 1 and 2). A punch biopsy specimen was obtained and was sent for review by the dermatopathologist (Figs 3 and 4). From the Departments of Dermatologya and Dermatopathology,b St Joseph Mercy Hospital, Ann Arbor, and the Midwest Center for Dermatology,c Clinton Township. Funding sources: None. Conflicts of interest: None declared. Correspondence to: Melba Estrella, MD, 1529 Hawkeye, Rochester Hills, MI 48307. E-mail: [email protected].
J Am Acad Dermatol 2015;73:e131-2. 0190-9622/$36.00 ª 2015 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2015.05.011
e131
e132 Morrison et al
1.
J AM ACAD DERMATOL
OCTOBER 2015
Based on the patient’s history and the photographs, what is the most likely diagnosis? A. Pityriasis rosea B. Erythema multiformeelike secondary syphilis C. Gonococcemia D. Rocky Mountain spotted fever E. Acute HIV exanthema
2.
What is the most appropriate treatment for this patient’s disease? A. Doxycycline 100 mg orally twice a day for 3 weeks B. Intramuscular benzathine penicillin 2.4 million units once weekly for 3 weeks C. Intramuscular benzathine penicillin 2.4 million units in a single dose D. Emollients and topical corticosteroids E. Prednisone tapered over 2 weeks
3.
What is the cause of this unique presentation? A. B. C.
Focal degeneration of collagen and elastic fibers and mucin deposition Immunologic defense against human herpesvirus-7 and -6 The endothelium is stimulated to produce toxic reactive oxygen species, and the infectious agent replicates within the endothelial cell until it bursts D. The infectious agent produces keratinases, which allow invasion into the stratum corneum E. Immune response against antigens of Treponema pallidum via the formation of immune complexes Please visit http://www.eblueimages.org to answer these questions.