Refractory Psoriatic Arthritis and Polyarteritis Nodosa: Co-occurrence in a Patient with Undiagnosed HIV

Human immunodeficiency virus (HIV) infection can result in several autoimmune illnesses, including psoriasis, psoriatic arthritis (PsA), and polyarteritis nodosa (PAN). We describe a patient who presented with PsA refractory to both synthetic and biologic disease-modifying antirheumatic drugs (DMARDs), who then developed PAN while on antitumor necrosis factor (TNF) therapy. The onset ofvasculitic disease led to the discovery of the HIV infection, and manifestations of both PsA and PAN remitted with the introduction of highly active antiretroviral therapy. To our knowledge, this is the first casewhere both PsA and PAN developed in an HIV-positive patient. Our review focuses on the pathogenesis, presentation, and treatment of HIV related psoriasis, PsA, and PAN. This unusual case underscores the need to remain vigilant for underlying HIV infection in immunosuppressed patients, and serves as a reminder ofthe unusual autoimmune manifestations the virus can provoke.