A 26-year-old man with a history of HIV - vanco

[ArchivalUser]

A 26-year-old man with a history of HIV infection/AIDS is evaluated for a sudden widespread eruption of skin lesions. His last office visit was 1 year ago when his CD4 cell count was 50/µL. At that time, trimethoprim-sulfamethoxazole, azithromycin, and highly active antiretroviral therapy were initiated, but the patient discontinued them owing to persistent nausea and vomiting and did not return for follow-up care until today.

On physical examination, he appears cachectic. Temperature is 38.3 °C (101.0 °F). Skin findings, which are widely disseminated but concentrated on the face, scalp, and neck, consist of 2- to 5-mm umbilicated papules with surrounding erythema.

The remainder of the physical examination is normal.

Which of the following is the most likely diagnosis?
A Cytomegalovirus infection
B Disseminated cryptococcal infection
C Herpes simplex virus infection
D Mycobacterium avium complex

[ArchivalUser]

I think Its C herpes cause vesicles with Erythema

[ArchivalUser]

if i had to, i'd go for C

Cheers!
Adrian

[ArchivalUser]

disseminated cryptococcal

[ArchivalUser]

thanks for the questions ...ur keeping the forum alive (now that it was pronounced dead of late)

[ArchivalUser]

@glofriends--can uplz explain y its Cryptococcal?

[ArchivalUser]

because its umblicated ....

[ArchivalUser]

hi gloworm : )

no no this forum IS very dead compared to the others... really.... i mean step one is on fire and matching+residency is still moving...

i think we are in competition with 'miscellaneous' for the gold... LOL!!

Cheers!
Adrian

[ArchivalUser]

Answer and Critique (Correct Answer: B)

Educational Objectiveiagnose disseminated cryptococcal disease based on dermatologic findings.


Cutaneous cryptococcosis, caused by the encapsulated yeast, Cryptococcus neoformans, is generally associated with concomitant systemic infection. A high index of suspicion is therefore mandatory in affected patients because cryptococcal skin involvement is nonspecific and produces a variety of lesions, including papules, nodules, plaques, vesicles, bullae, pustules, abscesses, cellulitis, ulcers, and purpura. The most typical lesions are asymptomatic and resemble molluscum contagiosum (also found commonly with HIV infection) and appear as small umbilicated papules with surrounding erythema most commonly on the face and scalp. Cryptococcal infection may occasionally be differentiated from molluscum contagiosum by the presence of a hemorrhagic center and an acute onset in the former. Diagnosis is confirmed by skin biopsy and fungal cultures.

Cytomegalovirus infection and Mycobacterium avium complex infection typically present as disseminated disease without skin lesions and are therefore not the most likely diagnoses in this patient.

Herpes simplex virus infection is usually characterized by the appearance of painful vesicles that lead to ulcerations on the oral mucosa or genital area, and the lesions typically are not asymptomatic, widespread, or concentrated on the face and scalp as they are in this patient.

[ArchivalUser]

thanks vanco.