Human immunodeficiency virus (HIV) leads to immunosuppression by depleting CD4+ T-cells. Psoriasis, a common immune-mediated inflammatory dermatosis, can paradoxically worsen or emerge as an initial presentation of HIV. The introduction of highly active antiretroviral therapy (HAART) in psoriatic patients with HIV may trigger severe psoriasis flare-ups, often linked to immune reconstitution inflammatory syndrome (IRIS).

This case involves a 31-year-old Filipino male with recurrent, resistant psoriatic plaques. Further testing revealed latent syphilis and HIV infection. The patient completed treatment for syphilis and began HAART, but developed erythrodermic psoriasis, likely due to IRIS. After an inadequate response to acitretin, guselkumab, an IL-23 inhibitor, was administered. The patient responded well, showing significant improvement after four months of treatment without adverse effects.

This case suggests that in severely immunocompromised patients with newly diagnosed HIV, adding guselkumab to conventional HAART may be a safe and effective option for controlling erythrodermic psoriasis flares triggered by immune reconstitution. However, further research is needed to assess the long-term safety and efficacy of guselkumab in HIV-associated psoriasis.

Human ; Male ; Adult: 25-44 Yrs Old ; Guselkumab ; Hiv ; Psoriasis

Introduction: Morphea, is a rare autoimmune disease presenting with fibrotic changes in the dermis and subcutis. It is a benign condition associated with significant atrophy and sclerosis leading to disfigurement, flexure contractures, and impaired function. Ultraviolet A1 and photochemotherapy are highly effective treatment options but are not readily available in the country. Narrowband ultraviolet B (NBUVB), on the other hand, is readily available, affordable, and safe to use. Case summary: Three patients diagnosed with different variants of morphea (bilateral generalize morphea, unilateral generalized morphea, and circumscribed morphea). underwent 30 sessions of NBUVB. Treatment response was assessed using tightness and itch Visual Analogue Scale (VAS), Modified Skin Score (MSS), photographic comparison, ultrasonographic measurement, and histopathologic analysis. NBUVB treatment resulted to 14-60% decrease in the tightness and itch VAS. MSS was also reduced by 35-50%. The size, pigmentation, and erythema of the lesions also decreased. Ultrasonography showed an improvement in the thickness of lesions after treatment. Histopathologic study showed less packed collagen with increase in inter-bundle spaces. Conclusion Response to treatment was influenced by the age of the lesion and anatomical location. More chronic lesions tend to have less response. Lesions on the face exhibited the greatest improvement while lesions on the lower extremities had the least improvement. This is the first case series study in the country that uses NBUVB as treatment for morphea. The improvement of the sclerotic and atrophic lesions treated with narrowband UVB treatment may be an acceptable substitute for UVA1 and PUVA.
Scleroderma, Localized ; Phototherapy

Herpes zoster is a clinical syndrome associated with reactivation of varicella zoster virus (VZV), often occurring years after VZV infection, and characterized typically by painful grouped vesicles in a dermatomal distribution. Bullous herpes zoster, an atypical presentation of herpes zoster, is a relatively rare phenomenon; to the authors’ knowledge, there have only been eight reports in worldwide literature. We present a case of a 59-year-old female with lupus nephritis who presented with multiple grouped vesicles evolving into large tender bullae filled with serosanguinous fluid on the lateral aspect of the right leg, and dorsal and medial aspects of the right foot, four days after the first dose of 1g of rituximab therapy. The diagnosis of bullous herpes zoster along L4-L5 dermatomes was made based on the clinical presentation and the presence of multinucleated giant cells on Tzanck smear. The giant bullae were drained and dressed, and the patient was treated with valacyclovir at the renally adjusted dose of 1g once a day for seven days and pregabalin 150 mg once daily. After seven days of antiviral treatment, there were no new bullae or vesicles, and the pain improved. Recognizing this atypical presentation of a common disease, especially in patients with an immunocompromised state, highlights the importance of prompt recognition and treatment.
Human ; herpes zoster ; lupus nephritis ; rituximab ; diagnosis, differential