Severe manifestation of psoriasis in a human immunodeficiency virus-infected patient: A case report
The human immunodeficiency virus (HIV) epidemic in Turkey reveals a slow progression and at the end of November 2015, the total official number was reported to be 11,109 cases. Approximately, 90% of HIV patients develop some type of skin disease. Especially, patients with psoriasis and HIV infection often present with more severe and treatment-refractory cutaneous disease. Herein, we describe a case of a patient with previously known psoriasis worsened by HIV infection. A 37-year-old homemaker was admitted to our clinic with previously known psoriasis worsened during the last 2 years with conversion to erythrodermic psoriasis which was not controlled even by psoralen ultraviolet A, methotrexate and systemic cyclosporine. The patient had positive HIV antibody test. HIV RNA viral load was 120.000 copy/ml, and CD4 count 88/mm3. She also had oral candidiasis and Pneumocystis jirovecii pneumonia. The patient received antiretroviral treatment including tenofovir/emtricitabine and lopinavir/ritonavir. Symptoms resolved gradually within 1 month with almost complete improvement of her erythrodermic psoriasis. Four years later, the patient was still on tenofovir/emtricitabine and lopinavir/ritonavir without concomitant specific psoriasis treatment. Psoriasis manifestations can be severe in acquired immune deficiency syndrome patients. Clinicians face diagnostic and therapeutic difficulties when psoriasis coexists with HIV infection. The HIV test should be considered in patients affected by severe erythrodermic psoriasis and resistant to conventional and biological treatments.