MKSAP: 32-year-old man with a rash on his face and midchest
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old man is evaluated for a 2-week history of a rash on his face and midchest. He describes the rash as consisting of small, reddish “lumps” that are intensely itchy; they develop and begin to resolve with development of new lesions. He otherwise feels well. Medical history is significant for a recent diagnosis of HIV infection. Medications are tenofovir, emtricitabine, efavirenz, and trimethoprim-sulfamethoxazole. On physical examination, vital signs are normal.
The patient has 1- to 3-mm papules and pustules on the face and central chest. There is no crusting or scaling in the web spaces, and no lesions on the umbilicus or penis. There is no lymphadenopathy or facial swelling. The remainder of the physical examination is unremarkable.
Laboratory studies:
Hemoglobin
Normal
Leukocyte count
3200/µL (3.2 × 109/L) with 9% eosinophils
Platelet count
Normal
CD4 cell count
170/µL
HIV viral load
8000 copies/mL
Creatinine
Normal
Liver chemistry tests
Normal
Which of the following is the most likely diagnosis?
A. Drug-induced acne
B. Drug reaction with eosinophilia and systemic symptoms (DRESS)
C. Eosinophilic pustular folliculitis
D. Scabies infestation
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Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Dermatology Infectious Disease Source Type: blogs
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