We present the case of a 40-year-old patient, polydrug addict since adolescence, with a first admission to prison at the age of 20, and with repeated admissions thereafter. In 1993, co-infection with HIV and HCV was detected. His medical history includes the prescription of the first ART in 1998, punctuated by constant withdrawals, especially during periods of freedom. Other pathologies of interest:
- pneumocystis jirovecii pneumonia (formerly called carinii) in 1998
- recurrent out-of-hospital pneumoniasis
- recurrent oropharyngeal, and probably oesophageal, candidiasis
- Pulmonary TB and brain lesions due to toxoplasmosis and/or TB
- almost constant seborrhoeic dermatitis
In August 2009, he presented with crusty, scaly, non-pruritic lesions initially on the scalp, ears and armpits. Subsequently, these lesions spread to the trunk and extremities, including soles and palms of the hands and feet. Similar lesions also appeared on the intergluteal fold and genitalia.
The dermatologist diagnosed psoriasis and prescribed treatment with calcipotriol plus betamethasone, salicylic petrolatum and tracolimus 0.1%. This treatment was not started until a new admission to prison at the beginning of 2010. In recent weeks, a slight improvement has been observed. At the beginning of the case, the CD4+ cell count was 64 with an HIV CV of 1,090,000 copies/ml (6.04 log). He also had significant cachexia (BMI < 16) and anaemia (Hbina 10 g/dl; Htcto. 30%). The patient has refused ART. He is currently in hospital to study the possible etymology of the brain lesions.

