Review Question - QID 109817

A 56-year-old man presents to his primary care provider with a 3-month history of violaceous papules and plaques around his nose and mouth, as seen in Figure A. He reports that the lesions have not bothered him too much, and there has not been any skin breakdown. The patient recalls getting all necessary immunizations throughout his life. On his social history, the patient reports that he lives alone and frequently engages in unprotected sexual activity with both men and women, with 2-3 different partners a month. On exam, his temperature is 97.5°F (36.4°C), blood pressure is 126/74 mmHg, pulse is 65/min, and respirations are 12/min. Which of the following describes the most likely cause for this patient’s findings?