Human immunodeficiency virus-associated psoriasis and psoriatic arthritis treated with infliximab

Sir, Patients infected with human immunodeficiency virus (HIV) may develop psoriasis and psoriatic arthritis. These patients often present more severe clinical manifestations than the non‐HIV population and treatment is difficult. We report a 46‐year‐old HIV+ man (CDC B3, World Health Organization) who presented with widespread psoriatic lesions (Fig. 1A) and inflammation of the knee and ankle joints. Laboratory examination revealed a CD4+ lymphocyte cell count of 68 mm−3, CD8+ lymphocytes of 839 mm−3, CD4/CD8 ratio 0·1. On initial examination, the plasma HIV‐1 RNA count was 1040 copies mL−1. After initiation of highly active antiretroviral therapy (HAART) with didanosine, lamivudine and lopinavir, the CD4+ cell count increased to 193 mm−3, CD8+ lymphocytes to 1388 mm−3, ratio 0·1. Simultaneously the psoriasis and polyarthritis worsened. The patient developed progressive swelling and redness of the knees (Fig. 1B), ankles, fingers and phalanges of the feet (Fig. 1C). Examination showed extensive psoriatic plaques all over his body. He exhibited scaly plaques on the palms and soles, accompanied by fluid‐filled pustules and dystrophy of all 20 nails.