Castillo Rochelle Lorenzo, Racaza Geraldine Zamora, Roa Francisca Dela Cruz
Section of Dermatology, Department of Medicine, University of the Philippines-Philippine General Hospital, Taft Avenue, Manila, Philippines.
Singapore Med J. 2014 Apr;55(4):e60-3. doi: 10.11622/smedj.2014062.
Knowledge of both the common and atypical presentations of human immunodeficiency virus (HIV)-associated dermatoses may be helpful in arousing suspicion of HIV, especially in patients with no reported risk factors. Herein, we report the case of an otherwise healthy, nonpromiscuous 29-year-old man who presented to our institution with an eight-week history of plaques with oyster shell-like scales on the trunk, extremities and genital area. The plaques were associated with fever, and intermittent knee pain and swelling. Initial diagnostic tests were suggestive of drug hypersensitivity syndrome, and the patient's condition improved with treatment using oral prednisone. However, the lesions recurred when the dose of prednisone was tapered, even after the culprit drug had long been discontinued. Repeat skin punch biopsy and arthrocentesis revealed a diagnosis of psoriasis vulgaris with psoriatic arthritis. Due to the atypical presentation of psoriasis, the patient was counselled to undergo HIV testing, which came back positive. Clinicians should be attuned to the skin signs heralding HIV/acquired immunodeficiency syndrome, in order to facilitate early diagnosis and treatment.
了解人类免疫缺陷病毒（HIV）相关皮肤病的常见和非典型表现，可能有助于引发对HIV的怀疑，尤其是在没有报告危险因素的患者中。在此，我们报告一例29岁健康、非滥交男性病例，他因躯干、四肢和生殖器部位出现有牡蛎壳样鳞屑的斑块8周病史前来我院就诊。这些斑块伴有发热、间歇性膝关节疼痛和肿胀。初步诊断检查提示药物超敏反应综合征，患者经口服泼尼松治疗后病情好转。然而，即使在可疑药物早已停用后，当泼尼松剂量逐渐减小时，皮损仍复发。重复皮肤打孔活检和关节穿刺检查确诊为寻常型银屑病伴银屑病关节炎。由于银屑病的非典型表现，建议患者进行HIV检测，结果呈阳性。临床医生应留意预示HIV/获得性免疫缺陷综合征的皮肤体征，以便早期诊断和治疗。
