Document 0245
 DOCN  M9590245
 TI    Longstanding psoriasis: a remission in a patient with AIDS and a falling
       T cell count.
 DT    9509
 AU    Hammett RJ; Edwards R; HIV Medicine Unit, Royal North Shore Hospital,
       University of; Sydney, St. Leonards N.S.W.
 SO    Annu Conf Australas Soc HIV Med. 1994 Nov 3-6;6:279 (unnumbered poster).
       Unique Identifier : AIDSLINE ASHM6/95291854
 AB    The development of psoriasis in patients with HIV/AIDS has been well
       described. In most reported cases there has been a deterioration in the
       patient's psoriasis with any decrease in CD4 count. Psoriasis in this
       setting is often resistant to conventional forms of therapy, although
       there have been reports of treatment success with PUVA therapy, and
       Vitamin D analogues. HIV itself can be identified within CD4 positive,
       Factor XIIIa dermal dendrocytes in patients with psoriasis; although the
       role it plays in the pathogenesis of the condition is uncertain. We
       present the case of a 59 year old HIV positive patient who had had
       widespread psoriasis for most of his adult life. The psoriasis involved
       the skin on the extensor aspects of the patient's elbows and knees, the
       abdomen and scalp. There was also evidence of pitting, ridging, and
       onycholysis of nails on both hands. He was diagnosed with HIV infection
       in May 1992, after presenting with a three month history of cough,
       dyspnoea and fever which was found to be due to Pneumocystis pneumonia.
       His CD4 count at the time of diagnosis was 243 x 1000 per cubic
       millimetre. At that time he had been receiving PUVA and topical
       treatment for his psoriasis. He was commenced on zidovudine, acyclovir,
       trimethoprim-sulphamethoxazole and nystatin. By April 1993 his CD4 count
       had fallen to 46 x 1000/cubic mm. Didanosine was started. He noted at
       this time that his psoriasis had improved markedly despite ceasing all
       treatment for it. He remained well until December 1993 when he developed
       septicaemia secondary to Mycobacterium Avium Intracellulare, and Staph.
       epidermidis. He was commenced on Rifampicin, Chlarithromycin, Ethambutol
       and Flucloxacillin, and recovered from this illness. At follow up in May
       1994 he remained relatively well; in particular his psoriasis had
       disappeared completely from his skin, with just three fingernails on one
       hand exhibiting some residual pitting. Similar improvements in disease
       activity have been noted in patients with Rheumatoid arthritis and
       Systemic lupus erythematosis, suggesting a role for CD4 cells in the
       pathogenesis of all of these conditions.
 DE    Acquired Immunodeficiency Syndrome/*IMMUNOLOGY  AIDS-Related
       Opportunistic Infections/IMMUNOLOGY  Case Report  CD4 Lymphocyte Count
       Human  Male  Middle Age  Psoriasis/*IMMUNOLOGY  Remission, Spontaneous
       *T-Lymphocytes/IMMUNOLOGY  MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).