Artikel
Exacerbation of psoriasis and psoriatic arthritis induced by combination therapy of COVID-19: a clinical case
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Autoren
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Daria Rumiantceva
- V.A. Nasonova Research Institute of Rheumatology, Laboratory of Spondyloarthritis and Psoriatic Arthritis, Moscow
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Екатерина Агафонова
- V.A. Nasonova Research Institute of Rheumatology, Laboratory of Spondyloarthritis and Psoriatic Arthritis, Moscow
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Tatiana V. Korotaeva
- V.A. Nasonova Research Institute of Rheumatology, Laboratory of Spondyloarthritis and Psoriatic Arthritis, Moscow
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Shandor Erdes
- V.A. Nasonova Research Institute of Rheumatology, Laboratory of Spondyloarthritis and Psoriatic Arthritis, Moscow
| Veröffentlicht: | 14. September 2021 |
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Gliederung
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History: The patient was a 46-year-old man. He had been diagnosed with stable PsA 16 years ago and had been treated with methotrexate 20 mg/week for 10 years. The COVID-19 symptoms, including fever, dry cough (for 9 days), dyspnea and debility had developed and resolved over the past 8 weeks. The chest computed tomography (CT) scan showed lung tissue damage 40%. Polymerase chain reaction (PCR) assay confirmed the diagnosis of COVID-19. He treated within 2 weeks in the hospital with ceftriaxone 1000 mg/day, azithromycin 500 mg/day, hydroxychloroquine 400 mg x2/day, enoxaparin sodium 0.4 mg/day, baricitinib 4 mg/day, dexamethasone 8 mg/day, humidified oxygen. Against the background of therapy patient's dyspnea was stopped, body temperature returned to normal, lung damage decreased to 15%. After few days of this treatment there was a deterioration of psoriasis in the form of widespread psoriatic erythroderma with lymphadenopathy and formation of pustules, as well as recurrence of arthritis, increased of the inflammatory back pain. Due to psoriatic erythroderma, the patient received intravenous glucocorticoids in large doses of at least 1000 mg with the effect on skin (relief of erythroderma).
Cardinal symptom by manifestation of disease: The patient presenting with generalized psoriasis vulgaris and plaques (PASI 37, DAPSA 112), onycholysis of the hands, arthritis of the knee, elbow, wrist joints, small joints of the hands and feet, deformation of the small joints of the hands and feet, IBP in the cervical, thoracic, lumbar spine (BASDAI 6.4, ASDAS CRP 3.2) over the past 4 weeks.
Diagnostics: On physical examination, active psoriatic lesions and plaques were found on the trunk, head and extremities. The results of laboratory tests, including complete blood cell count and biochemical tests, were normal. The levels of C-reactive protein (CRP) was 7.8 mg/l.
Therapy: The patient was initiated on therapy with an IL17A inhibitor - secukinumab 300 mg according to the scheme and continued methotrexate 20 mg/week.
Further course: After 1 week, a decrease in exudative phenomena in the joints, a decrease in the severity of cutaneous psoriasis (PASI 20), relief of erythroderma, relief of inflammatory back pain.
Disclosures: no
