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Case of the month #2

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History:

A 23 year old HIV positive female presented to a clinic in Swaziland complaining of various skin and mucosal nodules, difficulty breathing, and unilateral lymphedema for several months. Her CD4 count was 950 cells/mm3 at the time of the visit.

Clinical examination:

On the head and neck examination, the patient had a violaceous nodule on the palate and a mass within the oral pharynx which was beginning to obstruct her airway. She had lymphedema involving the entire left leg (Figure 1a), and bilateral inguinal lymphadenopathy was appreciated. On the right lower medial leg, the patient had a large eroded and friable nodule (Figure 1b), which was biopsied for further examination. In addition, the patient had numerous flesh-colored, dermal to subcutaneous nodules on the bilateral lower extremities.

Fig. 1a Fig. 1b

This case has been presented by Drs. Carrie Kovarik (1) and Daniel Dewey (2)
(1) Department of Dermatology, University of Pennsylvania, Philadelphia
(2) Baylor International Pediatric AIDS Initiative Center of Excellence, Mbabane, Swaziland

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