A 44-year-old man with a ...

A 44-year-old man with a history of HIV infection and intermittent adherence to antiretroviral therapy presented to the infectious disease clinic with a 1-month history of fevers and pruritic skin lesions. Physical examination was notable for blackish-brown lamellated plaques on the limbs and scalp. Laboratory studies were notable for a CD4 cell count of 86 per cubic millimetre (reference range, 414 to 1123) and a rapid plasmin reagin titer of 1:32. A skin biopsy of the left forearm showed diffuse dermal lymphocytes and histiocytes admixed with a plasma-cell infiltrate.