Granulomatous rosacea in a child infected with the human immunodeficiency virus

CASE REPORT A 4-year-old girl had an erythematous papular and papulopustular eruption on her cheeks (Fig. 1). Both of her parents are HIV positive, intravenous drug users. She also had weight loss, cervical lymphadenopathy, and oral candidiasis. A biopsy specimen from the face revealed tuberculoid granulomas surrounding the hair follicles. Demodex mites were observed within some granulomas (Fig. 2). Laboratory studies revealed HIV antibodies (enzyme-linked immunosorbent assay and Western blot) and p24 protein. Her CD4 count was 840/mm 3 with a CD4/CD8 ratio of 0.76. The tuberculin test was negative. Nevertheless, the patient was treated for 6 months with isoniazid and rifampin with no changes in the cutaneous lesions. A second biopsy specimen revealed the same findings as before. Oral erythromycin therapy, 250 mg/ day, resulted in sustained improvement.