33 year old male resident of quetta, fruit seller by profession k/c of HIV since 2.

5 years has presented

with c/o

Lesions on skin for 1 year

Acc to the pt he was in his usual state of health 3 years back with functional class 1 when he developed
loose stools multiple episodes per day large amount watery in consistency associated with food intake
and with generalized crampy abdominal pain and bloating, without any blood or mucus in it. He
developed generalized weakness with decrease in functional class to 3 along with difficulty in walking
and standing from sitting position. He also had documented weight loss of 12 kg in 6 months then He
went to multiple hospitals, got admitted for the complains, upper and lower gi endoscopy done showing
duedonal and colonic moderate inflammation. There was no relief in his symptoms until 2.5 year back
when he was diagnosed with HIV in civil hospital and started on treatment so his loose stools started to
settle and he started to gain weight.

Now since 1 year he started to develop pustular lesions on his body which started from left knee. These
lesions were small pustular multiple in numbers and associated with itching and purulent discharge.
They progressively increased to involve all four limbs and back with sparing of his chest and abdomen.

He is also complaining of fever since last 4 months high grade undocumented ass with chills and
excessive sweating but no rigors, intermittent with no diurnal variation and relive with Panadol.
However during the last 2 months his fever has reduced in intensity and frequency and now very
occasionally he develops a fever. There is no hx of cough sputum production, rhinorrhea post nasal drip
or sore throat, pus from ear or nose, jaundice, burning micturition hematuria or abdominal pain but
develops watery loose stools upon eating spicy food.

Patient has extensive travel history through out the Pakistan involving regions of balochistan and
northern areas. He is a smoker and charas addict and history of occasional drinking but no addiction. He
has positive sexual history of intercourse with an opposite gender without consent but no hx of i/v drug
abuse tattooing or tooth extraction. There is hx of blood tx twice, 1 before getting diagnosed with HIV
due to weakness and 1 after getting diagnosed. No tb or tb contact

Rest of the systemic review is unremarkable

Pmsh: admitted twice in last 2.5 years in quetta due to chronic diarrhea, no surgical hx

Family hx: grandmother has dm, khala had tb 3 years back, has 6 sisters and 3 brothers

Personal hx he is a fruit vendor, drinks tap water, bowl bladder and addictions as above

Social hx: he is the only earner in the family of 12, socioeconomic conditions are not good