A 41-year-old man with human immunodeficiency virus (HIV) infection was admitted with dyspnea on exertion and a nonproductive cough. He was successfully treated for pneumocystis jirovecii pneumonia. Admission physical examination revealed stigmata of four HIV-associated infections demonstrated in the two clinical images: 1) scarring from herpes zoster in the right ophthalmic (V1) distribution of the trigeminal nerve (Panel A, hollow arrow); 2) seborrheic dermatitis in the bilateral nasal folds (Panel A, asterisk); 3) oropharyngeal candidiasis (Panel B, arrow); and 4) oral hairy leukoplakia (OHL; Panel B, arrowhead).Dermatologic manifestations are common among patients with HIV and may provide a clinical indication of underlying immune status. Herpes zoster and seborrheic dermatitis tend to occur early in HIV infection and are associated with relatively high mean CD 4 cell counts (380/mm 3 and 450/ mm 3 , respectively) 1 . Oral candidiasis, the most common oral opportunistic infection in patients with HIV/AIDS, often presents at CD 4 cell counts less than 300/mm 3 2 . OHL is relatively specific for HIV infection and is highly predictive of the development of acquired immune deficiency syndrome (AIDS) 3 . It is associated with a mean CD 4 cell count of 143/mm 3 4 . The presence of both oral candidiasis and OHL together suggest more severe immune dysfunction; these concomitant infections are associated with a mean CD 4 cell count of 89/mm 3 5 . In one study, the joint occurrence of any two HIV-related oral lesions had a mean CD 4 cell count of 123/mm 3 and a 75% positive predictive value of finding a CD 4 cell count less than 200/mm 3 4 . Our patient had a CD 4 cell count of 32/mm 3 .