Treatment of severe plaque psoriasis complicated with HIV infection using secukinumab: a case report

We report a case of severe plaque psoriasis with HIV infection treated with secukinumab. A 62-year-old man presented with generalized erythemas, scaling and pruritus for 9 years, which aggravated for 4 months. Dermatologic examination revealed that the rash spread all over the body, involving approximately 70% of body surface area. On the scalp and extensor sides of the limbs, there were well-demarcated, infiltrative dark-red patches of varying sizes, covered with white oyster-shell-like scales and surrounded by erythema. On the scalp, there were multiple scaly red patches with bundled hair. On the elbows, anterior tibia, lumbosacral area, and lateral waist, the rashes merged into large patches. On the dorsal hands, fingers, and wrists, the skin lesions showed thickened infiltration. Positive signs included wax droplet phenomenon, film phenomenon, and pinpoint bleeding. Both wrists exhibited tenderness, and the interphalangeal joints of the right hand were mild swelling and pain, with discomfort during movement. The patient was previously diagnosed with HIV infection and syphilis. Laboratory tests showed HIV antibody screening and confirmation test (+), CD4+ T cells: 272 cells/μL, CD8+ T cells: 225 cells/μL, CD4+ T/CD8+ T: 1.21. TPPA (+) and RPR (-). Diagnosis: Severe plaque psoriasis, psoriatic arthritis and HIV infection. After 12-week treatment with secuchiumab and topical medications, the skin lesions largely subsided, leaving only light brown pigmentation. There was no recurrence during 32-week follow-up.