Maculopapular Rash in a Patient With Acquired Immunodeficiency Syndrome

Abstract

REPORT OF A CASE A 53-year-old homosexual man was admitted for the second time to the Veterans Administration Hospital, Houston. During his first admission, three months previously, Pneumocystis carinii pneumonia had been diagnosed. The patient was treated with sulfamethoxazole and trimethoprim (Bactrim). He developed a widespread maculopapular, blanchable, erythematous eruption. A biopsy specimen was interpreted by the dermatology consultant to be a drug rash secondary to sulfamethoxazole and trimethoprim therapy. The patient was then given pentamidine in lieu of sulfamethoxazole and trimethoprim, which resulted in the resolution of his rash. His course was complicated by bronchoscopy-related pneumothorax and Staphylococcus epidermidis cellulitis. He was also found to have esophageal candidiasis, abnormal liver function, decreased renal function, leukopenia, an inverted T-cell population ratio (38% suppressor and 3% helper cells), and elevated titers of cytomegalovirus (1:256) and Epstein-Barr virus (1:1,280). His condition improved, and he was discharged while receiving treatment with pentamidine, which