Severe HIV-associated psoriasis successfully treated with oral glucocorticoids and antiretroviral therapy: a case report

Background Psoriasis can be a presenting manifestation of HIV infection. HIV-associated psoriasis is often severe and resistant to treatment. Although systemic glucocorticoids (GCs) are generally discouraged because of concerns regarding the exacerbation of psoriasis and infectious complications, their efficacy and safety in the era of combination antiretroviral therapy (ART) remain unclear. Case presentation A 37-year-old Japanese man presented with widespread psoriasis refractory to topical therapy, with a Psoriasis Area and Severity Index score of 14.2. HIV-1 infection was newly diagnosed, with a serum HIV-1 RNA level of 690,000 copies/mL and a CD4-positive T-cell count of 102 cells/µL. Before ART initiation, he developed Pneumocystis jirovecii pneumonia (PCP), and was hospitalized. Trimethoprim-sulfamethoxazole therapy was initiated for PCP; however, fever persisted, prompting the addition of prednisolone (PSL) 30 mg/day. His fever resolved promptly, and psoriatic skin lesions also showed marked improvement. ART with bictegravir/emtricitabine/tenofovir alafenamide was initiated and PSL was gradually tapered and discontinued over five months. Psoriasis remained in remission without recurrence or the development of new opportunistic infections. Conclusions This case suggests that systemic GCs, when required for a concomitant condition, may provide temporary control of severe HIV-associated psoriasis until ART initiation.