A 46-year-old woman with AIDS and end-stage renal disorder (ESRD) on continuous ambulatory peritoneal dialysis (CAPD) presented with pain in her right thigh for three months. Recently, her CD4+ lymphocyte count was 145 per mL & plasma HIV RNA level was < 400 copies per mL. Doppler ultrasounds were negative for deep venous thrombosis on two different tests. She had been in stable health without any recent opportunistic infections.
Her past medical history was significant, with a history of shingles, orolabial herpes simplex disease, pancreatitis secondary to nucleosides, Candida esophagitis, and asthma. Her physical exam revealed an edematous right thigh and a tender, 3 × 5 cm irregular ecchymotic area present on her lateral thigh near a small shallow ulcer. A small vesicle preceded the ulcer. Laboratory data included: White blood cell count: 8.1K with 74% neutrophils Blood urea…
