Primary perianal healed lesions in a 33-year-old cisgender man with HMPX and well-controlled HIV on Biktarvy, imaged at lesion day 26.
Numerous 10-15-mm healed perianal lesions that are flat with central hypopigmentation and a peripheral rim of hyperpigmentation. After initially presenting with pharyngitis, fever, and a headache, numerous perianal lesions developed on illness day 3 and were associated with severe proctitis, perianal pruritis, and blood-tinged rectal discharge that resolved as the lesions healed. Over the following 26 days, the lesions progressed monomorphically through the stages of vesicles, then pustules that ulcerated, crusted, and desquamated, revealing new, healed skin as depicted here. By the time of first medical evaluation, these perianal lesions had mostly healed and there was no associated inguinal lymphadenopathy.