# Refractory Dermatophytosis and Oral Hairy Leukoplakia as Sentinel Manifestations of Advanced HIV Infection

## TL;DR

A 28-year-old woman with severe fungal skin infections and oral symptoms was found to have advanced HIV, highlighting these conditions as early warning signs.

## Contribution

This case highlights refractory dermatophytosis and oral hairy leukoplakia as sentinel signs of advanced HIV infection.

## Key findings

- Refractory dermatophytosis and oral hairy leukoplakia were linked to advanced HIV infection with low CD4+ T-cell count.
- Systemic terbinafine and antiretroviral therapy resolved the lesions within two months.
- Treatment-resistant mucocutaneous manifestations can signal advanced HIV.

## Abstract

Dermatophytosis is usually a benign superficial fungal infection, but in immunocompromised individuals, particularly those with advanced HIV infection, it may present with extensive, recurrent, and treatment-resistant lesions. We report the case of a 28-year-old woman with widespread dermatophytosis involving the trunk, extremities, and genital region, accompanied by oral hairy leukoplakia (OHL) on the lateral tongue. The lesions were refractory to repeated topical antifungal therapies, leading to diagnostic delay. Mycological analysis identified Trichophyton mentagrophytes. Further evaluation confirmed advanced HIV infection, with a cluster of differentiation 4 + (CD4+) T-cell count of 63 cells/mm³. Despite advanced immunosuppression, the HIV viral load was low-level and confirmed on repeat testing. The patient was treated with systemic terbinafine and antiretroviral therapy (ART) (Genvoya), resulting in marked improvement and the complete resolution of lesions within two months. This case emphasizes the diagnostic value of concurrent, treatment-resistant mucocutaneous manifestations as sentinel indicators of advanced HIV infection.