HIV infection was diagnosed in a 34-year-old man 3 years before he was hospitalized. The patient had a 2-week history of nausea; vomiting; and diffuse, intermittent, poorly localized abdominal pain. He had received radiotherapy and chemotherapy for Kaposi's sarcoma (KS) of the upper and lower extremities, which had been diagnosed 8 months earlier.
A 19-year-old man was admitted to the hospital with malaise, fatigue, and intermittent fever (temperature of 38°C [100.4°F]) for the last 2 weeks. Physical examination revealed scarce purpuric lesions over the lower extremities; a pericardial friction rub was audible over the precordium when the patient was supine and seated, and the spleen was remarkably enlarged.
A 35-year-old woman complained of pain or a burning sensation on her tongue when she ingested hot or acidic food and beverages. The white patch had spontaneously developed on her tongue 3 months earlier.
Fourteen months of intermittent, foul-smelling, perianal discharge prompted a 45-year-old man to seek medical evaluation. He also complained of occasional bright red rectal bleeding and soreness of the perianal region; he denied fever. The patient had undergone surgical drainage for episodes of perianal sepsis 2 years earlier.
A 32-year-old man who was seropositive for HIV presented with a tender lesion on his right foot of about 3 months' duration. The patient's only medication was zidovudine. His CD4+ cell count was 120/μL.
This 27-year-old man complained that a facial rash of several years' duration had worsened during the past few months. Hypopigmented macules with scale were especially prominent on the eyebrows and in the nasolabial folds; a moderate amount of scale was noted on the scalp. The patient was seropositive for HIV.
A 32-year-old man who had HIV disease complained of headache, fever, and weakness on his right side. His history included intravenous drug use, Pneumocystis carinii pneumonia, and mucocutaneous candidiasis.
Bleeding gums for the past 2 days was the complaint of this 22-year-old woman. She is HIV-positive but has been clinically asymptomatic. Her CD4 lymphocyte count is 84/μL, and her viral load is 160,885 copies/mL. Despite maintaining good oral hygiene, she has a distinct fiery red band along the gingival margin.
For 3 days, a 23-year-old woman had been bothered by pruritic vaginal and vulvar lesions. A cheesy white vaginal discharge was associated with the itching.
A 28-year-old man presented to the emergency department with a 1-week history of multiple, concentric, erythemic, targetlike plaques over the entire body. Severe necrosis and hemorrhagic crusting were evident on the oral mucosa and lesions were present on the upper lip. The remainder of the physical examination was unremarkable. The patient had no known medical problems, was seronegative for HIV, and denied a history of herpes simplex virus (HSV) infection. He used no medications.
A 30-year-old man, who was homeless, was admitted to the hospital with a several-month history of dyspnea and fever. He complained of producing excessive sputum and having frequent bouts of hemoptysis. Bilateral crackles were heard during examination of the lungs. The patient was in acute respiratory distress and was intubated to provide ventilatory support.
Three months ago, a 50-year-old man who was otherwise in good health noticed a hard, round nodule on his left arm. Within 2 months, similar nodules appeared all over his trunk, head, arms, and legs. The reddish purple lesions, less than 2 cm in diameter, were painless and slightly pruritic.
For 1 month, a 66-year-old man had had an asymptomatic lesion on the dorsum of his left hand. The flesh-colored, dome-shaped, maroon-crusted lesion measured 0.7 cm in diameter and was located over the fourth knuckle. The patient had chronic obstructive pulmonary disease but was otherwise in good health. He was seronegative for HIV.
A 40-year-old woman with AIDS had been feverish for the past 24 hours and had a nonproductive cough. She had smoked one pack of cigarettes daily for 20 years.
Erythromycin had been prescribed for a 15-year-old boy who complained of flulike symptoms. Twenty-four hours after starting the medication, he awakened with painful ulceration of his mouth and lips. The erythromycin was discontinued, and hydroxyzine (25 mg, three times daily) was started for possible macrolide sensitivity. His condition worsened over the next 3 days, however, and he was hospitalized when the severe oral pain made it impossible for him to tolerate food or drink. At no point had he any nausea, vomiting, diarrhea, fever, or chills.
Fever of 1 month's duration was this 28-year-old man's only complaint. He had smoked marijuana in the past but denied intravenous drug use. His temperature was 39.4°C (103°F), but no other abnormalities were noted on physical examination.
A 25-year-old man, who was an injection drug user, presented with a several-day history of dyspnea and fever. He complained of excessive malaise, fatigue, and weight loss but denied any hemoptysis. The examination of the lung revealed bilateral crackles in both lower zones.
A 43-year-old woman was hospitalized with a 3-day history of fever and back pain. She was malnourished and seropositive for HIV infection. Results of blood and sputum cultures were negative. A community-acquired pneumonia was diagnosed. Chest film findings and the clinical presentation were inconsistent with Pneumocystis carinii pneumonia.
Cough, fever, diarrhea, and weight loss had disturbed a 52-year-old woman for 1 month. AIDS had been diagnosed 5 years earlier, but she had declined medical treatment. The patient's vital signs were stable when she was admitted to the hospital. Physical examination results were unremarkable except for thrush and mild, diffuse abdominal tenderness.
A 2-week history of diarrhea mixed with bright red blood was the presenting complaint of a 40-year-old man who was seropositive for HIV. Stool studies and culture results were negative for microorganisms. Colonoscopy demonstrated only the raised vascular lesion seen here in the sigmoid colon, which may have been responsible for the bleeding.
Purplish skin lesions appeared on the back and trunk of a 34-year-old homosexual man with HIV-1 disease. The spots had been growing larger over the past several weeks.
A 33-year-old man with AIDS presented to the emergency department with fever, dyspnea, cough, and pleuritic chest pain of 3 days' duration. He had had a Pneumocystis carinii infection 3 years before recently emigrating from the Dominican Republic to the United States. Promiscuous sexual activity was his only risk factor for HIV infection. The patient did not take antiretroviral medications or protease inhibitors because of their cost.
While watching TV, a 32-year-old man experienced acute right-sided pleuritic pain and was taken to the emergency department. He was seropositive for HIV but had never had Pneumocystis carinii pneumonia (PCP) and was not taking aerosolized pentamidine. Physical examination revealed hyperresonance with significantly decreased breath sounds over the right hemithorax.
For 2 months, a 22-year-old uncircumcised man noticed an asymptomatic, erythematous, static lesion on the glans penis. He had applied an over-the-counter “jock-itch” ointment for 2 weeks but to no avail. The young man was otherwise healthy and denied having dysuria or a history of sexually transmitted disease.
Persistent, unremitting itch-which intensifies at night-is the chief complaint of patients with scabies. The female Sarcoptes scabiei mite (A) burrows into the stratum corneum, where she lays eggs. The parasite is transferred by intimate contact and fomites, such as infested clothing, towels, and bedding.
