An HIV-positive patient with cervical lymphadenopathy and skin lesions.

Clinical Infectious Diseases 2007; 44:849 2007 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2007/4406-0016$15.00 DOI: 10.1086/511860 A 23-year-old human immunodeficiency virus (HIV)–infected woman presented with a 5-month history of tender and progressive cervical lymph node enlargement and intermittent episodes of fever. She had noticed a tender skin nodule on her left leg 4 weeks before admission to the hospital. The lesion progressively enlarged, and new small lesions appeared on the patient’s right elbow. She was admitted to our hospital because of progressive malaise, weight loss, and anorexia. At admission to the hospital, the patient had temperature of 40 C and a pulse rate of 110 beats/min, and her blood pressure was within normal limits. The physical examination revealed confluent and tender lymph nodes with rubber consistency in the cervical region (figure 1A). A tender, reddish, pedunculated nodule was present on the left thigh (figure 1B and 1C). The patient’s CD4 cell count was 7 cells/mL, and her HIV load was 35,000 copies/ mL. The findings of a chest radiograph and an abdominal CT were normal. Cervical ultrasound demonstrated numerous adenopathies in an area 35 mm in diameter, with central areas of cystic degeneration and necrosis. An excision skin and lymph node biopsy was performed. What is your diagnosis?