Secondary healed lesion

Secondary healed lesion in a 60-year-old cisgender man with HMPX and well-controlled HIV on Genvoya and Prezista, imaged at lesion day 30.

Located on the lateral side of the distal right lower extremity is a 15-mm healing lesion with a peripheral rim of flaking and hyperpigmentation.  This lesion, part of a secondary crop of lesions, developed 7 days after illness onset, and was nonpruritic and nontender.

This lesion was preceded by right periauricular pain, headache, fever, chills, and malaise on illness day 1, tender bilateral inguinal lymphadenopathy on illness day 2, perioral and exquisitely tender and pruritic perianal lesions on illness day 5, and over the next week, lesions appearing on the trunk, extremities, and genitals.