A 49-year-old Caucasian male was referred to the Manchester Psoriasis Service with a 21-year history of severe chronic plaque psoriasis refractory to therapy with topical agents, phototherapy (TL-01), systemic agents (methotrexate, ciclosporin and fumaderm) and the biologic agents adalimumab and ustekinumab, including with concurrent ciclosporin therapy. Relevant history included alcohol excess. There was no family history of demyelination. Following a flare of psoriasis in June 2011, treatment was changed from ustekinumab (90mg dosing regimen) with ciclosporin 2mg/kg/day, to infliximab IV (5mg/kg at week 0, 2, 6, thereafter at 8 week intervals). This article is protected by copyright. All rights reserved.