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Acute HIV infection presenting as erythema multiforme in a 45-year-old heterosexual man

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Clinical record

A 45-year-old heterosexual man of European descent presented to our hospital with a 3-day history of fever, myalgia, headache and a macular papular rash. The rash originated on his left shoulder and anterior chest wall before extending to chest, back and abdomen. The rash also involved the palmar aspect of his hands and the plantar aspect of his feet.

He had a background history of dyslipidaemia, excessive alcohol consumption, gastro-oesophageal reflux disease, recurrent pancreatitis and gout. He had been taking statin medications, esomeprazole, allopurinol and creon for several years. There had been no new complementary medicines.

On arrival in hospital, his heart rate was 80 beats/min; respiratory rate, 16 breaths/min; blood pressure, 140/88 mmHg; and his temperature was 37.6°C. Cardiovascular, respiratory and abdominal examinations were otherwise unremarkable. Inguinal lymphadenopathy was noted on examination. A skin examination revealed an extensive macular papular rash affecting his face, trunk and limbs, with an erosion noted on his soft palate.