An 8-month-old black male with perinatally acquired HIV was admitted to the hospital with a temperature of 103 degrees Fahrenheit. He also had a 1-2 week history of erythematous papules covering the skin on his face, cheek, back and extremities, a firm subcutaneous nodule on his right anterior thigh and a small circular ulcerative lesion on his right lower eyelid. Physical examination was also notable for lymphadenopathy, hepatosplenomegaly, and hypertonicity. The patient had been receiving trimethoprim-sulfamethoxazole since four months of age. Prior medical history was notable for one episode of Klebsiella pneumoniae bacteremia and thrombocytopenia. At the time of admission this infant’s CD4 count was 566 (26%). A chest radiograph revealed bilateral pulmonary parenchymal nodular infiltrates. These findings were consistent with lymphoid interstitial pneumonitis, pulmonary lymphoid hyperplasia, or miliary tuberculosis.
A punch biopsy of the skin was performed on the second day of admission, which revealed skin and subcutaneous tissue with acute inflammation, necrosis and abscess formation primarily in the lower dermis and subcutis with extension into the fat. Unusual histiocyte-like organisms were seen in the biopsy specimen.
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