Differential Diagnosis for Rash in HIV

• Single most likely diagnosis:
  • Drug Reaction: Given the context of HIV, patients are often on multiple medications, including antiretroviral therapy (ART), which can cause skin rashes as a side effect. This is a common and well-documented phenomenon.
• Other Likely diagnoses:
  • Syphilis: Secondary syphilis can present with a rash and is more common in HIV-positive individuals due to the immunocompromised state.
  • Herpes Simplex or Zoster: Reactivation of herpes viruses is more common in immunocompromised patients, leading to skin rashes.
  • Fungal Infections: Such as candidiasis or dermatophytosis, which can cause rashes and are more prevalent in HIV-positive individuals.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Toxic Epidermal Necrolysis (TEN) or Stevens-Johnson Syndrome (SJS): Although rare, these conditions are life-threatening and can be triggered by medications used in HIV treatment. Early recognition is crucial.
  • Kaposi's Sarcoma: A type of cancer that can cause skin lesions and is associated with HIV infection, particularly in those with advanced immunosuppression.
• Rare diagnoses:
  • Mycobacterial Infections: Such as tuberculosis or atypical mycobacterial infections, which can cause skin manifestations in HIV-positive individuals.
  • Cryptococcosis: A fungal infection that can cause skin lesions among other symptoms, particularly in those with very low CD4 counts.