BACKGROUND
A 61-year-old woman with HIV infection and a CD4+
T-lymphocyte count of 280 cells per cubic millimeter presents with a
fever, pharyngitis, and dysphagia that have lasted 3 days. Her
physical examination is remarkable for an ulcerative lesion with
exudates in the left tonsillar fossa. She has no drooling or
stridor. The remaining physical findings are notable for generalized
lymphadenopathy; somnolence with arousability; and a generalized
rash with macules, papules, pustules, and vesicles, which primarily
appear on the face, trunk, and abdomen but not palms or soles. A CT
scan of the neck is obtained to evaluate for a retropharyngeal
abscess. The CT scan reveals an abnormal, asymmetric, soft tissue
thickening at the floor of the mouth and at the base of the tongue,
with epiglottic swelling and inflammation extending into the soft
tissues of the neck. The parotid gland is not involved. The white
blood cell count and blood chemistry findings are normal.
|
Hint
See the stain of a skin lesion. |
| Author:
|
Marilyn G. Foreman, MD,
David Oruma, MD, Sajiv Gugneja, MD, and H. Gene Stringer, MD
|
|
Morehouse School of
Medicine |
| eMedicine Editor:
|
John Leung, MD
|
|
Northwestern University,
Northwestern Memorial Hospital |  |
|
eMedicine
Case 
