Indurated Plaques and Persistent Ulcers in an HIV-1 Seropositive Man

REPORT OF A CASE A 29-year-old white transsexual intravenous drug user was admitted for evaluation of a persistent fever of 3 weeks' duration and suppurating ulcers over the right trochanter area. His history revealed viral hepatitis, secondary syphilis treated with penicillin, and acute pyelonephritis. Six years earlier, he was found to be positive for human im- munodeficiency virus type 1 (HIV-1). In 1986, he received multiple liquid silicone injections into the chin, malar and trochanter areas, and breasts. Admission temperature was 38.7°C. Physical examination revealed two symmetrical nontender, inflam- matory, indurated, diffuse and poorly delineated plaques over the external aspect of the thighs. Several grouped, ragged purulent ulcers with undermined borders were observed in the center of the right plaque (Figure 1). No lymph nodes were noted. Roentgenograms of the hips showed irregular soft-tissue densities with a mottled pattern without evidence of osteomyelitis. A chest roentgenogram was normal except for