Report of a case A 55-year-old heterosexual man presented with an asymptomatic maculopapular rash that had developed shortly after his return from a 4-week stay in Thailand, where he had had unprotected sexual contacts with local prostitutes. Other symptoms included fever, lymphadenopathy, myalgias, arthralgias, headache, and severe watery diarrhea, which finally led to his admission to our ward. Physical examination revealed distinct erythematous, partly purpuric maculopapular lesions distributed on his neck, face, and upper trunk area (Figure 1); a spotty, erythematous enanthem of the soft and hard palate (Figure 2); and an erosive balanoposthitis with concomitant Candida infection. Figure 1. View LargeDownload Figure 2. View LargeDownload Abnormal laboratory findings included leukopenia (leukocytes, 3.7 × 109/L; reference range, 4.3-10.0 × 109/L), lymphocytopenia (lymphocytes, 16% [reference range, 20%-51%]), shift to the left (band cells, 22% [reference value, ≤5%]), thrombocytopenia (platelets, 80 × 109/L [reference range, 140-440 × 109/L]), slightly elevated liver enzyme levels (aspartate aminotransferase, 25 U/L [reference range, 1-18 U/L]; γ-glutamyltransferase, 163 U/L [reference range, 6-28 U/L]), and markers of inflammation (C-reactive protein, 2.07 mg/dL [reference value, <0.1 mg/dL]). A bacterial or parasitic cause for the diarrhea was excluded, and the results of serological testing for a panel of viruses that commonly cause exanthem were unremarkable. The results of human immunodeficiency virus (HIV) antibody testing (enzyme-linked immunosorbent assay and Western blot) were negative, as were those of serological tests for syphilis. Remarkably, the ratio of CD4/CD8 lymphocytes was reversed (0.7; reference value, >1), with a relatively and absolutely decreased number of CD4-positive cells (607/µL). A skin biopsy specimen was obtained from one of the lesions on the upper trunk area (Figure 3). Figure 3. View LargeDownload What is your diagnosis?
Archives of Dermatology – American Medical Association
Published: Jan 1, 2002
Keywords: diarrhea,eruption, maculopapular