Primary infection with human immunodeficiency virus that presented as Stevens-Johnson syndrome.

SIR-When primary infection with human immunodeficiency virus (HIV) is symptomatic, it may influence the subsequent course of disease because of an increased risk for development of AIDS [1]. Although primary HIV infection usually manifests as a mononucleosis-like illness, clinical manifestations of this early stage of infection are heterogeneous [2]. We report what we believe to be the first case of Stevens-Johnson syndrome diagnosed during primary HIV infection. A 27-year-old heterosexual man who had had multiple sex partners and who had not been a drug abuser presented with a 15-day history of high fever (temperature, 40?C), vomiting, diarrhea, and a rash that was limited to the upper trunk. Physical examination revealed skin lesions typical of erythema multiforme. Multiple bullae with an erythematous base as well as painful erosions in the oral and genital mucosae, which had developed prior to the skin eruption, were noted. Other findings on physical examination were unremarkable, except for the presence of bilateral inguinal and cervical lymphadenopathy. The patient had not received any medication prior to the onset of these clinical manifestations. Confirmation of the diagnosis of Stevens-Johnson syndrome was obtained by examination of a biopsy specimen. The white blood cell count was 6 X 109/L, and the platelet count was 58 X 109/L. Aminotransferase levels were increased twofold. There was no serological evidence for recent infection with herpes simplex virus, cytomegalovirus, Mycoplasma pneumoniae, or Treponema pallidum. A repeated ELISA for antibodies to HIV was positive, although results had been negative 10 days before admission. An assay for HIV antigen was positive, and seroconversion was eventually confirmed by western blotting. The CD4+ lymphocyte count was .815 X 109/L. All the clinical and biological abnormalities resolved spontaneously within 2 weeks.