BMJ Case Reports 2013; doi:10.1136/bcr-2013-201184

Initial diagnosis of HIV/AIDS in a 56-year-old man with non-healing forearm lesion

  1. Sheela Shenoi
  1. Department of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Heidi J Zapata, heidi.zapata{at}


A 56-year-old Hispanic man with no significant medical problems presented with a 2-month history of a non-healing right forearm lesion that progressed despite several courses of empiric antibiotics. The patient underwent incision and drainage. Warthin-Starry stain with immunohistochemistry testing diagnosed bacillary angiomatosis secondary to Bartonella quintana. Subsequently, the patient was diagnosed with HIV, with a CD4 count of 68 cells/mm3, and a HIV viral load of 47, 914 copies/mL. The patient was treated with doxycycline and started on antiretroviral therapy. The lesion has resolved and he has had no recurrence after 16 months of treatment.

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