[Generalized pustular psoriasis activated by Klebsiella pneumoniae septicaemia]

Generalized pustular psoriasis is a severe form of psoriasis. The pustular dermatosis complicates a known psoriasis frequently after a medicinal taking or infection. It exceptionally inaugurates the psoriatic disease. We report a case of generalized pustular psoriasis triggered by Klebsiella pneumoniae septicaemia and discuss the characteristics of this association. A 43-year-old man, was hospitalized for a profuse pustular eruption evolving for one week with altered general state, fever and liquid diarrhea. The patient ate a tuna sandwich 48 hours prior to the onset of symptoms. The biology showed a hyperleucocytosis, elevated C Reactive Protein and hepatic cytolysis. The skin histology demonstrated a pustular psoriasis. Three blood samples, a coproculture and a catheter culture showed Klebsiella pneumoniae. The patient was treated with antibiotics. The pustular psoriasis was treated by acitretin. The evolution was gradually favourable. Generalized pustular psoriasis is a rare and severe affection. Its prognosis is mainly conditioned by infectious complications

[Psoriasis indicative of HIV infection progress to aids]

Psoriasis is a chronic inflammatory dermatosis which can appear before HIV infection in a patient with personal or family histories of psoriasis or which can be triggered by the HIV infection in a previously unaffected subject. The psoriasis with HIV is often more severe and refractory to classic psoriasis treatments. We report a case of psoriasis that revealed an HIV infection at the AIDS stage, and shall discuss the clinical and therapeutic characteristics of this association. A 40-year-old female has presented with a non pruriginous erythemato-squamous face and scalp eruption with palomplantar keratoderma and onychodystrophy of all toe nails evolving for one ear. On physical examination, an oral candidosis and chronic diarrhea were also noted. The diagnosis of common psoriasis was evoked and the investigations had revealed a lymphopenia at 610/mm[3]. The HIV serology was positive with CD4 at 31/mm[3] and viral load at 31,000 copies/ ml. A chest radiography had shown an apical left opacity due to pulmonary tuberculosis. In few days, the psoriasis extended to the whole integument. The patient was treated by antiretroviral therapy, antituberculosis drugs and local corticosteroids and ointments for her psoriasis. The evolution was quickly favourable. The recent psoriasis developed in an unaffected subject or the exacerbation of a former psoriasis can be associated with immune-suppression. HIV serology is required in such cases