Severe manifestation of psoriasis in a human immunodefciency virus-infected patient: A case report Alper Gündüz 1 , Nihal Aslı Küçükünal 2 , Dilek Yıldız Sevgi 1 , Ahsen Öncül 1 , Okan Derin 1 , Ali Seydi Alpay 1 , Ahmet Sanlı Konuklar 1 , Nuray Uzun 1 , İlyas Dökmetaş 1 Author afliations: 1 Department of Infectious Diseases and Clinical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey, 2 Department of Dermatology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey Correspondence to: alperg68@gmail.com (A. Gündüz) Abstract The human immunodefciency virus (HIV) epidemic in Turkey reveals a slow progres- sion and at the end of November 2015, the total ofcial number was reported to be 11,109 cases. Approximately, 90% of HIV patients develop some type of skin disease. Es- pecially, 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 an- tibody test. HIV RNA viral load was 120.000 copy/ml, and CD4 count 88/mm 3 . She also had oral candidiasis and Pneumocystis jirovecii pneumonia. The patient received antiret- roviral treatment including tenofovir/emtricitabine and lopinavir/ritonavir. Symptoms resolved gradually within 1 month with almost complete improvement of her erythro- dermic psoriasis. Four years later, the patient was still on tenofovir/emtricitabine and lopinavir/ritonavir without concomitant specifc psoriasis treatment. Psoriasis manifes- tations can be severe in acquired immune defciency syndrome patients. Clinicians face diagnostic and therapeutic difculties when psoriasis coexists with HIV infection. The HIV test should be considered in patients afected by severe erythrodermic psoriasis and resistant to conventional and biological treatments. Introduction Turkey is one of the countries in Europe with the lowest human immunodefciency virus (HIV) infection prevalence. After the identifcation of the frst cases of acquired immune defciency syndrome (AIDS) in 1981, the frst case from Turkey was reported in 1985 (1). Since then, the number of HIV patients revealed a slow progression, and at the end of November 2015, the total ofcial number was reported to be 11,109 (2). Approximately 90% of HIV patients develop some type of skin disease (3). Psoriasis is a chronic papulosqua- mous skin disease which is not more common among HIV-infected than HIV-uninfected patients. However, patients with psoriasis and HIV infection often present ©2015 Disease and Molecular Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Case Report Disease and Molecular Medicine disease & molecular medicine www.dismolmed.org Dis Mol Med 2015;3: 43-45 OPEN ACCESS d m m d m m with more severe and treatment-refractory cutaneous disease (3). We present a case of a patient with previ- ously known psoriasis worsened by HIV infection. Case Report A 37-year-old homemaker was admitted to our clinic with fever 38.6°C, cough, and shortness of breath. The patient had shortness of breath for 1 month which worsened during the last week. She had minimal plaque Received: November 15, 2015 Accepted: January 04, 2016 Dis Mol Med 2015;3: 43-45 Doi: 10.5455/dmm.20160104101140 Key words: Psoriasis, human immu- nodefciency virus infection, skin