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Q. What could be the rash on the back of my neck that appeared one year later after an infected needle prick?

Answered by
Dr. Dhepe Snehal Laul
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jan 10, 2022

Hi doctor,

I am a 28-year-old paramedical professional. I accidentally pricked my finger with a needle when I was giving IV one year back. After my work, I went to urgent care and tested for HIV using a fourth-generation antibody test. After a couple of days, the result came back negative. But two weeks after exposure, I developed vertigo and vomited a few times. I had a fever as well. After that, all the consecutive fourth-generation HIV tests taken after the first month, third month, and sixth month of exposure turned to be negative. I even did the Oraquick test, and it was also negative. With all these tests being negative, I still doubt whether I have been infected with HIV. My lymphocyte level is always borderline. I got myself tested for hepatitis C after seven months of exposure, and it was negative. I have taken the hepatitis B vaccine. I have attached a photograph of my neck. There is a rash that developed two days ago on my neck. What can it be? It is not painful or itchy. Kindly help.

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Hi,

Welcome to icliniq.com.

I had gone through the photographs (attachments removed to protect the patient's identity). It is not an HIV (human immunodeficiency virus) rash as tests are non-reactive. It is an atopic rash with secondary bacterial infection in the neck and P.versicolor (pityriasis versicolor) infection (a superficial fungal infection on the back). I suggest taking the following medicines;

a) Apply Ketoconazole lotion (Kevon stay on lotion) for 20 minutes before bath for 20 days (on back).

b) Apply Miconazole cream in the evening for ten days on neck lesion.

c) Fucidin (Fusidic acid) cream at daytime for ten days on neck lesion.

d) Avoid scratching and rubbing of the lesion.

e) Use Azac (Azelaic acid) soap for bathing for one month.

f) Avoid activities that cause sweating.

g) Wear loose, comfortable thin cotton clothes.

h) Maintain proper hygiene.

i) Tablet Teczine-M (Levocetirizine and Montelukast) once at night after food for seven days if itching.

Do you have any fever? Kindly reply.

Hi doctor,

Thank you for the reply.

I have a few more doubts. Could this be shingles? It is not painful or itchy. It is only painful if I touch it. I am terrified whether the rash is related to HIV or hepatitis C. I have heard that there can be some rare cases that do not show up in the tests.

#

Hi,

Welcome back to icliniq.com.

It is an atopic allergic rash with a secondary bacterial infection. I suggest taking the following medications and measures;

a) Apply Mupirocin ointment or Fucidin cream at daytime for ten days on neck lesion.

b) Avoid scratching and rubbing of the lesion.

c) Use Azac soap for bathing for one month.

d) Tablet Teczine-M once at night after food for seven days (anti-allergic tablet).

e) Apply Ketoconazole stay on lotion 20 minutes before bath for 20 days (on back ).

f) Apply Miconazole cream at night on the neck for ten days.

Excess sweating or moisture favors fungal growth. So avoid occlusion, friction, tight wear, and activities that cause sweating or moisture, or heat. Stay in a well-ventilated, cool room or environment. Insect bites may also cause bacterial infection. Tenderness on touch indicates possible bacterial infection. It is not related to HIV or hepatitis C. You will get the medication over-the-counter in a nearby pharmacy or medical store.

Have you got yourself tested for HSV (herpes simplex virus) 1 IgM (immunoglobulin M) or IgG (immunoglobulin G) and HSV 2 IgG or IgM? Herpes presents with a tingling or burning sensation and fever blisters. Do you have any tingling or burning sensation? Do you have any drug allergies or any history of insect bites or fever?

Hi doctor,

I am not sure of any insect bites. I do not have a fever. I had an issue with my left eye a month ago, and I was taking antibiotics for that as per the doctor's recommendation. He thinks it may be related to herpes simplex. I have not been sexually active for eight to ten years. No sexual contact at all. I am concerned about shingles because I heard this could be related to a weakened immune system.

#

Hi,

Welcome back to icliniq.com.

I suggest you take HSV 1 IgG or IgM and HSV 2 IgG or IgM tests. The symptoms of herpes include fever and grouped lesions like blisters, inflammatory papules, erosions, and ulcers. There will be a tingling or burning sensation, itching, and pain. These tests will be helpful to rule out the possibility of herpes. Have you done a Western blot test which is the confirmatory test for HIV?

Hi doctor,

I have not done the Western blot test since all my fourth-generation tests were negative. The area of my skin shown in the pictures is not itchy, but it is slightly painful. I can feel it like a throbbing pain in the back of my right lower neck. I have to schedule a time to get the mentioned tests done.

#

Hi,

Welcome back to icliniq.com.

I suggest you take the tests mentioned above to rule out herpes. The swab culture and microscopy of a collected swab from the lesion is another option to rule out possible infection. Non-reactive tests indicated negative results for HIV. So I suggest, stop associating every other symptom with HIV. I also recommend applying Fucidin cream or Mupirocin ointment twice daily for ten days and follow-up after ten days. I hope you find the reply useful.


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