ACUTE PSORIATIC FLARE DURING COVID-19 INFECTION AND RESPONSE TO MOLNUPIRAVIR: A CASE REPORT

COVID-19 is a global health problem caused by SARS-CoV-2 that manifests as influenza-like symptoms. This has posed concerns to the population, especially to people with long-standing comorbidities. Among these comorbidities is psoriasis, a chronic inflammatory condition manifesting as generalized, well-circumscribed erythematous lesions with silvery plaques. Psoriatic flares are triggered by factors such as stress and infections. The treatment prior to the advent of the COVID-19 pandemic was the conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) such as methotrexate or the biologic DMARDs. There have only been a handful of case reports on psoriatic exacerbations during COVID-19 infection, so local literature is still lacking, with little to no available published data detailing its response to antivirals such as Molnupiravir. This report thus aims to present a 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, she has been in remission. She developed influenza-like symptoms 3 days prior to admission. Thereafter, erythematous maculopapular rashes coalescing into plaques appeared. She tested positive for SARS-CoV-2 infection and was managed as a confirmed mild COVID-19 case along with a psoriatic flare. Molnupiravir, which is an orally bioavailable cytidine analog with antiviral activity, was used in the COVID-19 treatment on the first hospital day with a csDMARD (Methotrexate) administered on the third hospital day. No documented adverse events occurred; fever lysed and lesions began clearing by the fifth day. This report provides additional input in establishing optimal treatment and helps drive the therapeutic approach for psoriatic exacerbations during COVID-19 infection, including the effect of Molnupiravir with csDMARDs in mitigating flare-ups, the possibility of side effects, and the probability of drug-to-drug interactions.