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The prevalence of psoriasis in HIV disease has been reported to be the same as that in the general population, occurring in approximately 1–3% of HIV-positive individuals. 1,2 The clinical manifestations of psoriasis observed in HIV-infected individuals are similar to those in non-HIV-infected individuals with some variations, but the clinical behavior of psoriasis appear to be different. These patients responds poorly to treatment and have a high morbidity rate, thus posing a challenge to clinicians. We present a case of severe psoriasis associated with an undiagnosed HIV infection, with no response to classic therapy that improved after initial ART (Anti Retroviral Therapy).