A man in his sixties with a recently diagnosed HIV infection was admitted because of skin lesions progressing up his right arm over a month prior to admission. Approximately 3 months before this admission, he developed nausea, vomiting, diarrhea and a thirty-pound weight loss. He was admitted to a hospital and was found to be HIV-positive. His CD4 T-lymphocyte cell count was 54 cells cells per microliter (reference range 328–1404) and the HIV RNA level was 602,870 copies per milliliter.
During that hospitalization, he was also diagnosed with Campylobacter gastroenteritis, cytomegalovirus (CMV) enteritis and oral candidiasis. On examination, there was a small non-inflamed nodule on the distal interphalangeal joint of his right index finger, which was biopsied. Histopathologic staining of the biopsy revealed acid-fast organisms and the specimen was sent for culture.…
