Keratotic papules and nodules and hyperkeratosis of palms and soles in a patient with tuberculosis and AIDS-related complex

Patients with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex are subject to exaggerated clinical expression of infectious diseases. Widespread keratotic papules and striking hyperkeratosis of the palms and soles went unrecognized as a manifestation of tuberculosis, thereby delaying treatment in a patient with AIDS-related complex. Reliance on special stains from skin or lymph nodes to diagnose tuberculosis is inappropriate because organisms may not be detected and culture of the organism from the skin may be difficult.