Pruritic Plaques in a Man with AIDS

Prepared by Herbert L. Fred, MD, Professor, and LaTanya Jones Love, MD, Senior Resident, Department of

Internal Medicine, The University of Texas Health Science Center, Houston

Proteus, Pseudomonas

Staphylococcus

A38-year-old man presented with a fever of 2 days' duration. He was known to have AIDS with pruritic skin lesions. Physical examination showed a rectal temperature of 104̊F and sharply demarcated, thick plaques with distinct borders and silvery scales covering most of his body (Figure 1). His palms and soles were hyperkeratotic, and his fingernails were thick, brown, and fissured (Figure 2). Blood cultures grew , and species. Biopsy specimens from several plaques were consistent with hyperkeratotic psoriasis.

After treatment with vancomycin HCl, cefepime HCl, and sulfamethoxazole/trimethoprim, the fever disappeared. The skin lesions resolved during the ensuing 2 months without additional therapy.

Points to remember: In patients with AIDS, psoriasis is often severe and refractory to conventional therapy. Occasionally, however, as in this case, the lesions may clear after treatment for a concomitant infection.

Mimickers of psoriasis in patients with AIDS include Norwegian scabies, mycosis fungoides, keratoderma blenorrhagica, pemphigus foliaceus, and hypertrophic lichen planus.

Diagnosis: Hyperkeratotic psoriasis.