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Picture of the Month Quiz

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Image of figure 2

Figure 1.

Figure 2.

A 2-month-old boy was admitted because of a 4-day history of fever, cough, purulent nasal discharge, and skin lesions. He had been born via spontaneous vaginal delivery, at low birth weight, to a mother who had received no prenatal care. At delivery, maternal serological results were negative for hepatitis B, hepatitis C, and rapid plasma reagin but positive for human immunodeficiency virus (HIV); maternal HIV infection was not previously known. Diagnosis of HIV in the neonate was confirmed and antiretroviral treatment was started.

Physical examination revealed a blood-tinged nasal discharge, upper respiratory tract noises, and palpable hepatosplenomegaly. Erythematous to copper-red macules and papules were distributed over the trunk and extremities, including the palms and soles (Figure 1). Many lesions had peripheral or concentric desquamation. Fissures were seen on the lips (Figure 2). Laboratory investigation showed anemia, with schistocytes on peripheral blood smear and negative results on a Coombs test. A skin biopsy was performed from a lesion on 1 leg.

For a complete discussion of this month's case, read next month's Picture of the Month—Quiz Case. For a complete discussion of last month's case, read this month's Picture of the Month—Quiz Case.