Cluster of ulcerated and pustular lesions in the perianal region

Cluster of ulcerated and pustular lesions in the perianal region in a 27 year old unvaccinated Middle Eastern cisgender man living with HIV on suppressive antiretroviral therapy with a near-normal CD4 count. This image was taken 6 days after the onset of symptoms and was accompanied by systemic symptoms (fever, fatigue, chills) and rectal pain, discharge and bleeding.