IJOMAHIP Published Article Details

Abstract COVID-19 is a global health problem caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), manifesting as influenza-like symptoms. This posed concerns to the population specifically to people with comorbidities. Among these comorbidities is psoriasis, a chronic inflammatory condition that manifests as generalized well-circumscribed erythematous lesions with silvery plaques. Psoriatic flares are triggered by factors such as stress and infection. In particular, there have been reports on psoriatic exacerbation following COVID-19 infection. The approach to treatment prior to COVID were the conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) such as methotrexate or biologic DMARDs that are effective in controlling exacerbations. However, aside from reports detailing response to topical medication, there is lacking evidence that could drive our approach in dealing with psoriasis exacerbations during COVID-19 infection. Local literature has been lacking and there has been no available data on the response to antivirals. This report thus aims to present the case of a 67-year-old female with psoriasis who was noted to have an acute psoriatic flare during COVID-19 infection. She was diagnosed with psoriasis 26 years prior and was maintained on topical steroids. Her last severe psoriatic flare was 14 years prior and since then has been in remission. She developed influenza-like symptoms 3 days prior to admission. Thereafter, erythematous maculo-papular rashes coalescing into plaques appeared. She tested positive for SARS-CoV-2 infection and was managed as a confirmed mild COVID along with a psoriatic flare. Molnupiravir, which is an orally bioavailable cytidine analog with antiviral activity used in COVID-19 treatment, was started on the first hospital day with methotrexate on the third day. No adverse events, fever lysed and lesions began clearing by the fifth day. This report provides additional input in establishing optimal treatment for psoriasis during COVID-19 infection. KEYWORDS: acute psoriatic flare, COVID –19 infection, Molnupiravir, case report