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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 96-99

Psoriasis flare-up and new-onset psoriatic arthritis induced by severe acute respiratory syndrome coronavirus 2 infection


Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar

Date of Submission19-Nov-2020
Date of Acceptance10-Apr-2021
Date of Web Publication23-Jul-2021

Correspondence Address:
Dr. Mohammad N Kloub
Department of Internal Medicine, Hamad Medical Corporation, P. O. Box: 3050, Doha
Qatar
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_98_20

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  Abstract 


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, discovered in December 2019 in China is now a pandemic affecting >200 countries worldwide. The general population is susceptible to infection, however elderly people and those with a background of chronic medical illnesses are at increased risk for severe symptoms and complicated outcomes. The SARS-CoV-2 virus usually establishes itself and replicates in the respiratory system and can establish infection in the upper part of the respiratory tract as well as the lower part of the respiratory tract, presenting in a spectrum ranging from asymptomatic infection reaching up to severe acute respiratory distress syndrome,; however, SARS-CoV-2 infection can affect other systems of the human body as many cases have been reported where the patients present with different bodily system symptoms without having respiratory symptoms as usual. We report a case of a 44-year-old male patient who had a psoriasis flare-up and new-onset psoriatic arthritis likely induced by SARS-CoV-2 infection.

Keywords: Psoriasis, psoriatic arthritis, severe acute respiratory syndrome coronavirus 2


How to cite this article:
Kloub MN, AlHiyari MA, Yassin MA. Psoriasis flare-up and new-onset psoriatic arthritis induced by severe acute respiratory syndrome coronavirus 2 infection. Libyan J Med Sci 2021;5:96-9

How to cite this URL:
Kloub MN, AlHiyari MA, Yassin MA. Psoriasis flare-up and new-onset psoriatic arthritis induced by severe acute respiratory syndrome coronavirus 2 infection. Libyan J Med Sci [serial online] 2021 [cited 2021 Sep 27];5:96-9. Available from: https://www.ljmsonline.com/text.asp?2021/5/2/96/322211




  Introduction Top


Coronavirus pneumonia is a novel respiratory disease in humans that is caused by the novel coronavirus. This virus was first discovered in China in December 2019, The WHO has officially named this disease coronavirus disease 2019. Up to this date, six coronaviruses that can infect humans have been identified (HCoV-229E, HCoV-OC43, HCoV-NL63, HCoV-HKU1, severe acute respiratory syndrome coronavirus (SARS-CoV), and Middle East respiratory syndrome-CoV.[1] The newly discovered coronavirus is a β-coronavirus that has enveloped virus particles that are spherical or oval.[2] The epidemiological data provided by Huang et al. showed that the Huanan Seafood Wholesale Market in Wuhan was the source of the zoonosis.[3]

Although SARS-CoV-2 infection targets mainly the respiratory tract, there was a wide variety of reported complications involving other systems, including but not limited to neurological system involvement (stroke, encephalitis, epileptic seizures, and others),[4] autoimmune system (cytokine release syndrome and others),[5] cardiovascular System (arrhythmias, myocarditis, and others).[6]

Cutaneous manifestations of SARS-CoV-2 have been described in a limited number of case reports and case series. The first report of SARS-CoV-2-related cutaneous manifestations by Recalcati showed that 18 from 88 SARS-CoV-2-positive patients (20.4%) developed skin lesions.[7] Among the skin lesions related to SARS-CoV-2 reported, the majority of these lesions were found on the trunk, hands, and feet. A generalized macular or maculopapular exanthem was the most common cutaneous manifestation, followed by chickenpox-like vesicles, and cold urticaria.[8] Psoriasis is an immune-mediated genetic skin disease, and various factors can trigger psoriasis in genetically predisposed individuals or exacerbate the disease when it is in remission.[9]


  Case Report Top


We report, herein, the case of a 44-year-old male patient who has a medical history significant of psoriasis and gouty arthritis on chronic medical treatment. He presented with a history of epigastric pain that started progressively after having his lunch meal 1 day before admission, pain was progressive and dull and localized to the epigastrium, associated with nausea and vomiting of gastric content twice.

On presentation patient was found to have a cholestatic pattern of hyperbilirubinemia, on initial physical examination patient was icteric and had mild epigastric tenderness.

Initial laboratory investigations are shown in [Table 1].
Table 1: Initial laboratory investigations at presentation

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The abdominal US revealed contracted gallbladder with biliary sludge and a stone measuring 6.5 mm, patient admitted as a case of acute cholecystitis but decided to be managed conservatively and to schedule an elective laparoscopic cholecystectomy to be done at a later time.

As part of HMC protocol to screen patients presenting to emergency for SARS-CoV-2, nasopharyngeal swab was sent for the patient and turned to be positive, so the patient was transferred to a SARS-CoV-2 facility as per protocol as a case of asymptomatic SARS-CoV-2 infection as the patient never developed respiratory symptoms nor fever. Over the next 2 days of patient's hospital stay, he started complaining of itchy skin lesions and joints pain. General examination was remarkable for the presence of itchy erythematous well-defined plaques on the neck and scalp also involving the abdomen, trunk, bilateral legs, and bilateral feet [Figure 1], [Figure 2], [Figure 3]. He was also found to have swollen tender bilateral metacarpophalangeal joints. The patient was diagnosed with a case of psoriasis flare-up and psoriatic arthritis and started on Travocort cream, Mometasone lotion, Vaseline, Levocetrezine, and Celecoxib for psoriatic arthritis. The patient was followed up daily closely and continued on management, he started showing improvement and skin lesions and joint swelling improved dramatically and was discharged to be followed as outpatient for further management [Figure 4], [Figure 5], [Figure 6].
Figure 1: Erythematous psoriatic abdominal plaques

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Figure 2: Erythematous psoriatic back plaques

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Figure 3: Erythematous psoriatic foot plaques

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Figure 4: Healing abdominal psoriatic plaques

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Figure 5: Healing psoriatic plaques over the back

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Figure 6: Healing psoriatic plaques over the foot

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  Discussion Top


Psoriasis is a chronic inflammatory skin disease with a strong genetic predisposition and autoimmune pathogenic traits. The worldwide prevalence is about 2% but varies according to regions.[10] Activation of the innate immune system driven by endogenous danger signals and cytokines characteristically coexists with an autoinflammatory perpetuation in some patients, and T cell-driven autoimmune reactions in others. Thus, psoriasis shows traits of autoimmune disease on an (auto) inflammatory background.[11] However, patients with SARS-CoV-2 have a state of hyperinflammation and may cause exacerbation of psoriasis.[12]

Cases of psoriasis flare-ups likely induced by SARS-CoV-2 have been reported.[12],[13] One case of a 48-year-old male who presented with respiratory symptoms and he had a psoriasis flare-up during her 4th day of hospital stay.[12] Another patient of a 27-year-old female with psoriatic arthritis triggered by SARS-CoV-2.[13]


  Conclusion Top


Flare-up of psoriasis and new-onset psoriatic arthritis can be induced by SARS-CoV-2 infection, even without being started on SARS-CoV-2 medications, these complications should be acknowledged and managed promptly.

Acknowledgment

The authors would like to acknowledge the internal medicine and infectious disease departments at Hamad Medical Corporation for supporting this publication.

Ethical consideration

Written informed consent was obtained from the patient to allow the publication of information including images. The case was approved by HMC Medical Research Center.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Xu P, Zhou Q, Xu J. Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol 2020;99:1205-8.  Back to cited text no. 1
    
2.
Chen Z, Zhang W, Lu Y, Guo C, Guo Z, Liao C, et al. From SARS-CoV to Wuhan 2019-nCoV outbreak: Similarity of early epidemic and prediction of future trends. BioRxiv 2020;doi:10.1101/2020.01.24.919241.  Back to cited text no. 2
    
3.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Feb 15;395:497-506. doi: 10.1016/S0140-6736(20)30183-5.  Back to cited text no. 3
    
4.
Carod-Artal FJ. Neurological complications of coronavirus and COVID-19. Rev Neurol 2020;70:311-22.  Back to cited text no. 4
    
5.
Zhang C, Wu Z, Li JW, Zhao H, Wang GQ. Cytokine release syndrome in severe COVID-19: Interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality. Int J Antimicrob Agents 2020;55:105954.  Back to cited text no. 5
    
6.
Cheng P, Zhu H, Witteles RM, Wu JC, Quertermous T, Wu SM, et al. Cardiovascular risks in patients with COVID-19: Potential mechanisms and areas of uncertainty. Curr Cardiol Rep 2020;22:34.  Back to cited text no. 6
    
7.
Recalcati S. Cutaneous manifestations in COVID-19: A first perspective. J Eur Acad Dermatol Venereol 2020;34:e212-3.  Back to cited text no. 7
    
8.
Bouaziz JD, Duong T, Jachiet M, Velter C, Lestang P, Cassius C. Vascular skin symptoms in COVID-19: A French observational study. J Eur Acad Dermatol Venereol 2020;34:e451-2.  Back to cited text no. 8
    
9.
Kamiya K, Kishimoto M, Sugai J, Komine M, Ohtsuki M. Risk factors for the development of psoriasis. Int J Mol Sci 2019;20:4347.  Back to cited text no. 9
    
10.
Christophers E. Psoriasis – Epidemiology and clinical spectrum. Clin Exp Dermatol 2001;26:314-20.  Back to cited text no. 10
    
11.
Liang Y, Sarkar MK, Tsoi LC, Gudjonsson JE. Psoriasis: A mixed autoimmune and autoinflammatory disease. Curr Opin Immunol 2017;49:1-8.  Back to cited text no. 11
    
12.
Ozaras R, Berk A, Ucar DH, Duman H, Kaya F, Mutlu H. COVID-19 and exacerbation of psoriasis. Dermatol Ther 2020;34:e13632.  Back to cited text no. 12
    
13.
Novelli L, Motta F, Ceribelli A, Guidelli GM, Luciano N, Isailovic N, et al. A case of psoriatic arthritis triggered by SARS-CoV-2 infection. Rheumatology (Oxford) 2021;60:e21-3.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

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