A Missed Opportunity: Indicator Disease Guided Testing for HIV

We report on a 42 year old, heterosexual black man presenting with an anal ulceration and generalized itch. Upon inspection, hyper pigmented disseminated cutaneous patches, non-removable whitish parallel plaques on the lateral borders of the tongue, and, moreover, residual hyper pigmentation and scarring on the right side of the abdomen after an episode of herpes zoster were observed. Based on the clinical suspicion of Kaposi sarcoma and oral hairy leukoplakia an advanced infection with HIV was suspected and, eventually, confirmed. This case highlights the necessity of HIV testing in patients suffering from various indicator diseases including skin diseases such as herpes zoster or seborrheic dermatitis. This approach may not only help to prevent further morbidity in affected patients and consequently transmission of HIV, but also proves to be cost effective.