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Dermatology · STI: HIV skin manifestations
Sample itemAn HIV positive patient with a CD4 count of 120 has intensely itchy, urticarial follicular papules on the face, neck and upper trunk, with peripheral eosinophilia and raised IgE. Biopsy shows eosinophilic infiltrate around follicles. What is the diagnosis?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Eosinophilic folliculitis
Eosinophilic folliculitis is an intensely itchy sterile follicular eruption in advanced HIV, with sebocyte-directed inflammation and eosinophils. It often improves with ART and phototherapy, and topical steroids, itraconazole or antihistamines can help.
Option by option
A. Bacterial folliculitis
Bacterial folliculitis shows pustules with neutrophils and positive cultures.
B. Eosinophilic folliculitis (correct)
Correct. A sterile, itchy follicular eruption with eosinophilia is typical.
C. Kaposi sarcoma
Kaposi sarcoma has violaceous plaques with spindle cells.
D. Pityrosporum folliculitis
Pityrosporum folliculitis shows yeasts in follicles and neutrophils or mixed infiltrate.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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