A 33-year-old African woman who was HIV positive and being treated with zidovudine and zalcitabine presented with a 4-week history of a generalized pruritic rash superficially resembling molluscum contagiosum. The appearance of the lesions appeared to coincide with a dramatic decrease in her peripheral CD8+, and to a lesser extent, CD4+ T-lymphocyte count. Hematologic investigations revealed anemia with eosinophilia and she had a strongly positive Strongyloides antibody test. The eruption persisted despite appropriate antihelminthic treatment and temporary withdrawal of antiretroviral therapy. Histologic examination showed ill-defined nodules of necrobiotic collagen with surrounding palisading mononuclear cell infiltrate consistent with granuloma annulare. The rash disappeared spontaneously over several weeks.
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