Atypical Human Papillomavirus Infection with Secondary Tinea in a Middle-Aged Caucasian Male

We present a case of an atypical diffuse cutaneous eruption due to HPV infection and Tinea in a 51-year-old male patient with a past medical history of mild cytopenia, vasectomy and difficult socio-economic situation. Differential diagnosis at initial visit included Epidermodysplasia Verruciformis vs Pityriasis Rubra Pilaris vs Secondary Syphilis vs Xanthoma Disseminatum vs atypical presentation of Tinea vs less likely other. Through clinical examination, repeat biopsy, tissue culture and extensive HPV testing, it was revealed that the patient had multiple HPV infections type FA52, 96, 16 and 13, with a possible secondary Tinea infection. The patient was treated with antifungal medications first.  Topical Cidofovir was recommended but not covered by insurance. The skin eruption improved gradually  highlighting the importance of additional samples, tissue culture and extensive HPV testing in such atypical cases. Our case describes the importance of multidisciplinary care to help patients with proper diagnostics and treatment regimens.