Abstract

A 48-year-old male with Fitzpatrick skin type II and a medical history of acquired hypothyroidism due to thyroid cancer was admitted to the hospital with a three-day history of asymptomatic exfoliative dermatitis, left-sided vision loss, and slurred speech. He reported using permethrin for scabies five weeks earlier and then again two weeks later but denied any other new medications. The physical examination revealed erythroderma with exfoliative scale covering more than 80% of the body, ulcerations extending to the scrotum, patchy alopecia, and onychomadesis. Two shave biopsies were taken, and histological examination revealed dense parakeratosis with neutrophils, microabscess formation, supra-papillary plate thinning, and a lymphocytic infiltrate consistent with psoriasiform dermatitis. Additionally, large intranuclear inclusions were noted in the endothelial cells of the superficial papillary dermal vasculature consistent with cytomegalovirus (CMV) infection. The patient was subsequently found to be positive for human immunodeficiency virus (HIV) and syphilis. This is an interesting case of erythrodermic psoriasiform dermatitis and concomitant disseminated CMV infection as the presenting symptoms in a patient with HIV infection.