SHM Converge Scientific Abstract ePoster Gallery-Immune Reconstitution Inflammatory Syndrome Leading to Diffuse, Pustular Psoriasis

Pdf Summary

A 35-year-old man with HIV/AIDS (CD4 count 60) and recently treated secondary syphilis developed an acute worsening of a chronic rash after restarting Biktarvy. On exam, he had a widespread eruption of oval pink scaly plaques and papules with marked flexural involvement. The initial differential was broad and included disseminated bacterial or fungal infection, recurrent secondary syphilis, and a primary dermatologic disorder.<br /><br />Because of concern for infection, he was treated empirically with systemic antibiotics and antifungals. However, punch biopsy showed findings consistent with pustular psoriasis, and stains were negative for infectious organisms. After dermatology consultation, antimicrobials were stopped and he was started on topical steroids and a short course of cyclosporine. Outpatient follow-up was not yet available to assess response.<br /><br />The case highlights that diffuse rash in people living with HIV can reflect infection, infestation, neoplasm, or inflammatory disease. Psoriasis has a paradoxical relationship with HIV: despite immunosuppression, it may be triggered or worsened, and immune reconstitution can also precipitate it. In patients with HIV, psoriasis is often severe, widespread, and difficult to treat. While plaque psoriasis is most common, any subtype can occur, including pustular psoriasis.<br /><br />Management should follow a stepwise approach based on severity, using topical therapy, phototherapy, and immunomodulatory agents when needed.

Asset Subtitle

Nicholas Austin

Meta Tag

Author List Christopher M. O'Donnell, Nicholas Austin

Category Clinical Vignettes

Concept Disseminated Rash

Concept HIV

Concept Immune Reconstitution Inflammatory Syndrome

Concept Pustular Psoriasis

Concept Differential Diagnosis

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Nicholas Austin

Track Adult

Keywords

HIV/AIDS

pustular psoriasis

diffuse rash

secondary syphilis

Biktarvy

immune reconstitution

skin biopsy

flexural involvement

topical steroids

cyclosporine

Disseminated Rash

HIV

Immune Reconstitution Inflammatory Syndrome

Pustular Psoriasis

Differential Diagnosis