Chief Complaint: “I have persistent skin rashes and sores that don’t seem to heal.”

History of Present Illness:
A 34-year-old man presents with complaints of multiple skin rashes and non-healing sores over the past three months. He first noticed small red patches on his arms and chest, which later developed into raised, scaly lesions. Some areas have become darker and ulcerated. He also reports occasional itching and burning sensations. Additionally, he has been experiencing unexplained weight loss, night sweats, and chronic fatigue.

The patient recalls having frequent bouts of oral thrush in the past year and a few episodes of prolonged diarrhea. He has not sought medical attention before and denies any known history of chronic illnesses.

Physical Examination:

• Multiple hyperpigmented, scaly plaques on the chest, arms, and back
• Non-healing ulcers on the legs and oral mucosa
• White, thick patches on the tongue and inner cheeks
• Mild generalized lymphadenopathy
• No signs of acute systemic infection, but the patient appears thin and fatigued

Diagnosis:
The presence of multiple persistent skin lesions, oral candidiasis, and systemic symptoms raises strong suspicion of HIV infection with cutaneous manifestations. Skin conditions such as seborrheic dermatitis, Kaposi sarcoma, eosinophilic folliculitis, and opportunistic infections (e.g., fungal and bacterial skin infections) are common in individuals with HIV. The history of recurrent oral thrush and unexplained weight loss further supports the need for HIV testing.

Management Plan:

• HIV Testing and Counseling: Immediate HIV screening and confirmatory testing
• Treatment for Skin Lesions: Topical and systemic antifungals for oral thrush and possible fungal skin infections; biopsy of any suspicious lesions
• Antiretroviral Therapy (ART): If HIV is confirmed, initiation of ART to control viral load and improve immune function
• Supportive Care: Nutritional support, management of secondary infections, and psychological counseling

The patient is scheduled for follow-up with an infectious disease specialist to confirm the diagnosis, assess his immune status (CD4 count and viral load), and begin appropriate treatment.