Pustular psoriasis and arthropathy in a patient with HIV infection. Clinical case

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Abstract

The article presents a clinical case of pustular psoriasis and arthropathy in a patient with HIV infection. The diagnosis of psoriasis was confirmed by morphological examination. Signs of arthropathy were confirmed by X-Ray: presence of oligoarthritis of the distal interphalangeal joints of the fingers and feet was seen. Dactylitis severity ― 2–3 points, the Ritchie index ― 2, DLQI ― 28. The clinical course of psoriasis and its treatment in HIV-infected patients was considered after taking into account the data from literature and the patients current condition and observation. The above observation of a combination of several clinical forms of psoriasis (vulgar, pustular and arthropathy) in patients with HIV infection is an illustration of the features of the course and comorbidity of chronic dermatosis and AIDS, due to the influence of the infectious process, immunosuppression and ART. The development of pustular form and arthropathy creates the additional challenge of prescribing basic systemic treatment for severe and complicated psoriasis in an HIV-infected patient due to the presence of contraindications due to comorbidity. The glucocorticosteriod selected by the committee was effective on the skin and joint pathological processes, without having any negative impact on the course and treatment of the HIV infection. Such cases require further study and development of methods for the treatment of patients with comorbidity and their inclusion in an additional section in the clinical recommendations for the diagnosis and treatment of psoriasis.

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About the authors

Valery V. Dubensky

Tver State Medical University

Email: valerydubensky@yandex.ru
ORCID iD: 0000-0003-2674-1096
SPIN-code: 3577-7335

MD, Dr. Sci. (Med.), Professor

Russian Federation, 4 Sovetskaya street, 170000 Tver

Elizaveta G. Nekrasova

Tver State Medical University

Email: nekrasova-7@mail.ru
ORCID iD: 0000-0002-2805-6749
SPIN-code: 5831-5824

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, 4 Sovetskaya street, 170000 Tver

Vladislav V. Dubensky

Tver State Medical University

Email: dubensky.vladislav@yandex.ru
ORCID iD: 0000-0002-5583-928X
SPIN-code: 6044-8507

MD, PhD, Professor of the Department of Dermatovenerology with the course of Cosmetology

Russian Federation, 4 Sovetskaya street, 170000 Tver

Olga A. Alexandrova

Tver State Medical University

Email: olyaxandrova@gmail.com
ORCID iD: 0000-0001-8281-3619
SPIN-code: 8080-0721

Assistant at the Department of Dermatovenereology with a course of cosmetology

Russian Federation, 4 Sovetskaya street, 170000 Tver

Ekaterina S. Muraveva

Tver State Medical University

Author for correspondence.
Email: katerisha87@yandex.ru
ORCID iD: 0000-0001-5326-4876
SPIN-code: 3332-8424

Assistant at the Department of Dermatovenereology with a course of cosmetology

Russian Federation, 4 Sovetskaya street, 170000 Tver

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Supplementary files

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2. Fig. 1. Patient I., 44 years old. Pustular psoriasis and arthropathy before treatment: а ― pustular psoriasis on the skin of the palms; in the area of the tenor and hypotenor ― non-follicular pustules on the background of infiltration and hyperkeratosis, scaly-crusts; б ― psoriatic rashes on the distal parts of the fingers of the hands; pronounced hyperkeratosis in combination with onycholysis of the nail plates; signs of acute dactylitis of the I, II, V fingers and "radish-like" defiguration of the I–IV fingers; в ― psoriatic rashes on the distal parts of the toes; pronounced hyperkeratosis in combination with onycholysis of the nail plates; acute dactylitis of the I, IV, and V toes.

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3. Fig. 2. The same patient. Histological picture of Barber's pustular psoriasis: the preparation subcorneally determines the spongioform pustule of Kagoi; against the background of acanthosis, there are separate granulocytic neutrophil infiltrates. Stained with hematoxylin-eosin, ×100.

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4. Fig. 3. The same patient after treatment: а ― rashes and infiltration on the skin of the palms resolved with residual hyperpigmentation; б ― psoriatic rashes on the skin of the hands were resolved; onychia with hyperkeratosis and onycholysis; mild defiguration of the fingers of the hands; в ― psoriatic rashes on the skin of the feet have resolved; onychia with hyperkeratosis and onycholysis; mild defiguration of the toes.

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