Photoquiz: Generalized violaceous papulosquamous eruptions in an HIV-positive female

Abstract

A 25-year-old woman gravida 2, para 2, presented to the dermatology clinic for evaluation of a one-month history of a generalized asymptomatic rash. The patient had a history of poorly controlled Human Immunodeficiency Virus (HIV) infection with non-compliance to antiretroviral therapy, and prior chlamydia and gonorrhea infections. Additionally, she complained of a headache, which was unrelieved by aspirin, paracetamol, and caffeine. The patient denied vomiting, neck stiffness, tingling, numbness, or fatigue. Mucocutaneous examination revealed several ill-defined violaceous papules and plaques with peripheral scaling over her face, trunk, and extremities, including her palms and soles (Figure 1A). Additionally, there were multiple ill-defined healing erosions with peripheral serpiginous violaceous borders present in the buccal mucosa (Figure 1B). The lesions over the palms and soles were well-demarcated with a coppery hue (Figure 1C). Furthermore, there were well-defined violaceous papules over the labia majora (Figure 1D). Severe tenderness was elicited by applying gentle pressure to the lesions on the back. What is the diagnosis? A) Subacute Cutaneous Lupus Erythematosus B) Rocky Mountain Spotted Fever C) Lichen Planus D) Secondary Syphilis

Keywords

• hiv
• syphilis
• infectious disease
• sexually transmitted diseases