ERUPTION OF HUMAN-IMMUNODEFICIENCY-VIRUS SEROCONVERSION

A 34-year-old Caucasian man, previously in excellent health, was admit ted to Mount Sinai Hospital in September 1996 with an acute illness, i ncluding high fevers, malaise, sore throat, and a mucocutaneous erupti on. On examination, he had a temperature of 38.5 degrees C, Cutaneous findings included a severe seborrheic dermatitis and an exanthem chara cterized by multiple erythematous macules and papules, some with a hem orrhagic center, distributed on the trunk and proximal extremities (Fi g. 1). Subtle palmer petechiae were noted. The mouth contained an enan them with palatal petechiae and a well-circumscribed erosion (Fig. 2). Koplik's spots were not present. Hepatosplenomegaly and lymphadenopat hy were absent. Complete blood count revealed a white blood count of 2 600 with a differential of 46% polymorphonuclear cells, 25% bands, 25% lymphocytes, and 4% monocytes. His hemoglobin was 11 g/dL and his pla telet count was 90,000. A lymphopenia (0.7 (normal range 1.0-4.5 x 100 0)) and an elevated PTT were also present. The routine biochemistry pr ofile was within normal limits. Monospot was negative. There were no a ntibodies to hepatitis B or C, Coxsackie virus, Epstein-Barr virus, me asles, herpes, toxoplasmosis, or cytomegalovirus antigen. The patient was immune to measles. Rapid plasma reagin (RPR) was nonreactive. Two months prior to presentation, human immunodeficiency virus (HIV) antib ody testing was negative. A biopsy specimen from a lesion on the upper part of the chest demonstrated a mild interface dermatitis (Fig, 3), consistent with a drug reaction or viral exanthem. Acid fast, Dieterle , and Gram stains of the biopsy specimen failed to reveal microorganis ms. Serological testing for HIV DNA by polymerase chain reaction (PCR) was positive. PCR testing for HIV RNA recorded in excess of 7 million copies/mm(3). Triple antiretroviral therapy with Saquinavir, AZT, and 3TC was initiated. The eruption cleared completely within one week of its onset. Six weeks later, seroconversion to HIV antibody positivity occurred. Eight weeks after starting therapy, the patient experienced severe nausea and vomiting and became icteric, and all medications we re withdrawn. The patient recovered and has not experienced any furthe r illness in 1 year of follow-up.