Cutaneous thrombosis in human immunodeficiency virus type 1-positive patients and cytomegalovirus viremia

In a group of over 900 patients infected with human immunodeficiency virus type 1 (HIV-1) who underwent follow-up for cutaneous disease, we have seen 17 patients in whom evidence of thrombotic disease developed ( Table ). The majority of patients have presented with peripheral thrombophlebitis or strokes as their presenting thrombotic incident; however, we have seen two patients whose first sign of a hypercoagulable state was digital infarcts (Table) ( Figure 1 ). The case reports of the two patients with cutaneous infarction illustrate this serious complication of HIV-1 infection. Report of Cases.Case 1. A 28-year-old HIV-1-positive Walter Reed stage 6 (last CD4 count, 0.09 × 10 9 /L 1 year before) black man presented with acute onset of multiple digital infarcts of both upper extremities (Figure 1). The patient had had periodic low-grade fevers for over 4 months. Multiple blood cultures for bacteria, mycobacteria, and fungi were all negative. Coagulation studies included the following