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An Unexpected Visitor

      For patients with advanced HIV infection, the environment is teeming with potentially dangerous pathogens. A 48-year-old male with AIDS (as indicated by his CD4 count) presented to the hospital with the chief complaint of shortness of breath. His CD4 count was 87 cells/mm3; his viral load was>100,000 HIV RNA copies/mL; he had never been treated with highly active antiretroviral therapy; and he was not compliant with trimethoprim/sulfamethoxazole prophylaxis for opportunistic infections. He also reported a skin lesion on the face that appeared approximately 2 months prior to admission without any history of trauma.
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