A patient with HIV presents with symptoms including fever, targetoid skin lesions, and significant skin sloughing. What is the likely diagnosis?

The presence of fever, targetoid skin lesions, and significant skin sloughing in a patient with HIV strongly indicates Stevens-Johnson syndrome (SJS). This condition is characterized by a severe reaction that leads to necrosis and sloughing of the skin and mucous membranes.

In SJS, the targetoid lesions, which resemble those seen in erythema multiforme, are part of the clinical presentation, along with systemic symptoms such as fever. The fact that the patient is immunocompromised due to HIV increases the likelihood of such drug-induced reactions, as individuals with weakened immune systems can have exacerbated responses to medications that trigger SJS.

The differentiation is essential because SJS represents a more limited form of skin detachment compared to toxic epidermal necrolysis (TEN), which is associated with even more extensive skin involvement. Although both SJS and TEN can be caused by similar agents and have overlaps in symptoms, the extent of skin sloughing and the clinical presentation can help guide the diagnosis.

In this context, scabies would typically present with intense itching and burrows on the skin, psoriasis tends to be more chronic and does not typically cause such acute symptoms, nor present in this manner, and toxic epiderm