Share this Article
Castillo RL, Racaza GZ, Roa FC
Correspondence: Dr Rochelle L Castillo, shellycastillo@gmail.com
ABSTRACT
Knowledge of both the common and atypical presentations of human immunodeficiency virus (HIV)-associated dermatoses may be helpful in arousing suspicion of HIV, especially in patients with no reported risk factors. Herein, we report the case of an otherwise healthy, nonpromiscuous 29-year-old man who presented to our institution with an eight-week history of plaques with oyster shell-like scales on the trunk, extremities and genital area. The plaques were associated with fever, and intermittent knee pain and swelling. Initial diagnostic tests were suggestive of drug hypersensitivity syndrome, and the patient’s condition improved with treatment using oral prednisone. However, the lesions recurred when the dose of prednisone was tapered, even after the culprit drug had long been discontinued. Repeat skin punch biopsy and arthrocentesis revealed a diagnosis of psoriasis vulgaris with psoriatic arthritis. Due to the atypical presentation of psoriasis, the patient was counselled to undergo HIV testing, which came back positive. Clinicians should be attuned to the skin signs heralding HIV/acquired immunodeficiency syndrome, in order to facilitate early diagnosis and treatment.
Keywords: AIDS, HIV, ostraceous psoriasis, psoriasis vulgaris, psoriatic arthritis
Singapore Med J 2014; 55(4): e60–e63; http://dx.doi.org/10.11622/smedj.2014062
REFERENCES
| 1. Fauci AS, Clifford Lane H. Human Immunodeficiency Virus Disease: AIDS and Related Disorders. In: Longo DL, Kasper DL, Larry Jameson J, Fauci AS, Hauser SL, Localzo J, eds. Harrison's Principles of Internal Medicine, 18th ed. Berkshire: McGraw Hill Medical, 2012: 557. | ||||
| 2. Aftergut K, Cockerell CJ. Update on the cutaneous manifestations of HIV infection. Clinical and pathologic features. Dermatol Clin 1999; 17:445-71. http://dx.doi.org/10.1016/S0733-8635(05)70101-7 | ||||
| 3. Rieger A, Minsue Chen T, Cockerell CJ. Cutaneous Manifestations of HIV Infection and HIV-related Disorders. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology, 3rd ed. Amsterdam: Elsevier, 2012: 1285-302. | ||||
| 4. Cedeno-Laurent F, Gómez-Flores M, Mendez N, et al. New insights into HIV-1-primary skin disorders. J Int AIDS Soc 2011; 14:5. http://dx.doi.org/10.1186/1758-2652-14-5 | ||||
| 5. Bartlett BL, Khambaty M, Mendoza N, et al. Dermatological management of human immunodeficiency virus. Skin Therapy Lett 2007; 12:1-3. | ||||
| 6. Montazeri A, Kanitakis J, Bazex J. Psoriasis and HIV infection. Int J Dermatol 1996; 35:475-9. http://dx.doi.org/10.1111/j.1365-4362.1996.tb01658.x | ||||
| 7. Mallon E, Bunker CB. HIV-associated psoriasis. AIDS Patient Care STDS 2000; 14:239-46. http://dx.doi.org/10.1089/108729100317696 | ||||
| 8. Langley RG, Krueger GG, Griffiths CE. Psoriasis: epidemiology, clinical features, and quality of life. Ann Rheum Dis 2005; 64(Suppl II):ii18-23. http://dx.doi.org/10.1136/ard.2004.033217 | ||||
| 9. Duvic M, Johnson TM, Rapini RP, et al. Acquired immunodeficiency syndrome-associated psoriasis and Reiter's syndrome. Arch Dermatol 1987; 123:1622-32. http://dx.doi.org/10.1001/archderm.1987.01660360050012 | ||||
| 10. Schon MP, Boehncke WH. Psoriasis. N Engl J Med 2005; 352:1899-912. http://dx.doi.org/10.1056/NEJMra041320 | ||||
| 11. Menon K, Van Voorhees AS, Bebo BF Jr, et al. Psoriasis in patients with HIV infection: from the medical board of the National Psoriasis Foundation. J Am Acad Dermatol 2010; 62:291-9. http://dx.doi.org/10.1016/j.jaad.2009.03.047 | ||||
| 12. Fernandes S, Pinto GM, Cardoso J. Particular clinical presentations of psoriasis in HIV patients. Int J STD AIDS 2011; 22:653-4. http://dx.doi.org/10.1258/ijsa.2011.010525 | ||||