History: Older man presented with new onset, painless ulcerated nodule. Pearly borders and overall morphology virtually pathognomonic for basal cell carcinoma. We were SURPRISED when curettage specimen was read as gelatinous cryptococcosis. He was recalled and a careful total body search disclosed two small similar lesions on the trunk. Both biopsied; both crypto. He had a blood transfusion in the distant past and denied all other risk factors for HIV infection. He was found to be HIV+ with a CD4 count of 175.
Unusual care where deep fungal infection presenting sign of HIV. He remains alive with normalized CD4 and undetectable HIV load in HAART.