Symptoms and Signs – Differential Diagnosis of HIV Infection, Cutaneous Manifestations
BACTERIAL INFECTION • Bacillary angiomatosis: numerous angiomatous nodules associated with fever, chills, weight loss • Staphylococcus aureus: folliculitis, ecthyma, impetigo, bullous impetigo, furuncles, carbuncles • Syphilis: may occur in different forms (primary, secondary, tertiary); chancre may become painful because of secondary infection FUNGAL INFECTION • Candidiasis: mucous membranes (oral, vulvovaginal), less commonly Candida intertrigo or paronychia • Cryptococcoses: papules or nodules that strongly resemble molluscum contagiosum; other forms include pustules, purpuric papules, and vegetating plaques • Seborrheic dermatitis: scaling and erythema in the hair-bearing areas (eyebrows, scalp, chest, and pubic area) ARTHROPOD INFESTATIONS • Scabies: pruritus with or without rash, usually generalized but can be limited to a single digit VIRAL INFECTION • Herpes simplex: vesicular lesion in clusters; perianal, genital, orofacial, or digital; can be disseminated • Herpes zoster: painful dermatomal vesicles that may ulcerate or disseminate • HIV: discrete erythematous macules and papules on the upper trunk, palms, and soles are the most characteristic cutaneous finding of acute HIV infection. • Human papillomavirus: genital warts (may become unusually extensive) • Kaposi’s sarcoma (herpesvirus): erythematous macules or papules; enlarge at varying rates; violaceous nodules or plaques; occasionally painful • Molluscum contagiosum: discrete umbilicated papules commonly on the face, neck, and intertriginous sites (axilla, groin, or buttocks) NONINFECTIOUS • Drug reactions: more frequent and severe in patients with HIV infection • Nutritional deficiencies: mainly seen in children and patients with chronic diarrhea; diffuse skin manifestations, depending on the deficiency • Psoriasis: scaly lesions; diffuse or localized; can be associated with arthritis • Vasculitis: palpable purpuric eruption (can resemble septic emboli)
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