Guttate Psoriasis: Rash With a Diagnostic Dilemma in a Patient With AIDS

Guttate psoriasis is a clinical subtype of psoriasis seen most commonly following a streptococcal infection in younger patients. We present a case of an adult man with advanced untreated HIV who developed a diffuse, scaly rash unresponsive to empiric antibiotics. Extensive infectious work-up was unrevealing. Skin biopsy confirmed guttate psoriasis, which improved with topical corticosteroids. This case highlights the diagnostic complexity of dermatologic presentations in HIV-positive patients, in which both infectious and noninfectious causes must be considered. It also illustrates the multifactorial relationship between HIV and psoriasis, including paradoxical immune dysregulation and the individualized approach required for diagnosis and management.