Papillomatous Anogenital Lesions in a Patient With Human Immunodeficiency Virus.

Abstract

A 45-year-old African American man with history of human immunodeficiency virus (HIV) presented to the office complaining of a rash in his right groin for the past 7 weeks. He had a history of nonadherence to his combination antiretroviral therapy (cART), and at a previous visit, his HIV-1 load was noted to be >10 000 000 copies/mL. After that visit, the patient became adherent with his cART regimen. He presented to his primary care physician’s office 3 weeks later, reporting a lesion in his right groin, and was treated with doxycycline for possible skin and soft-tissue infection. Blood work performed 2 weeks later showed an HIV-1 viral load of 1604 copies/mL. The patient was seen in the infectious disease clinic and reported that the rash had only gotten worse. He described it as “itchy but not painful.” He denied fevers, chills, night sweats, unexplained weight loss, nausea, vomiting, and diarrhea. At physical examination, the patient appeared well developed and well nourished. No oropharyngeal thrush was seen at oral examination. Findings of neurological, cardiovascular, respiratory, and abdominal examination were also unremarkable. Skin examination revealed multiple exophytic masses in the right inguinal and perineal areas, the largest measuring about 3 cm in diameter, and areas of hypopigmentation (Figure 1). There was no associated erythema or tenderness to palpation. The CD4 cell count was 59/μL, and the HIV load, 733 copies/mL. The patient was referred to dermatology for biopsy. What is your diagnosis?