Post COVID-19 treated with AstraZeneca vaccine exacerbates arthritis with susceptibility to herpes in an older woman: A case report

RATIONALE: Rheumatoid arthritis (RA) is an autoimmune inflammatory disorder that has seriously affected human health worldwide. This report describes a rare case of herpes infection, secondary to RA, that emerged after coronavirus disease 2019 (COVID-19) infection or vaccination. Despite pharmacological intervention for arthritis, herpes, and mental health symptoms, the patient's condition has not improved. PATIENT CONCERNS: A 70-year-old female homemaker, weighing 110 lbs, sought urgent care for persistent dysphoric mood and irritability attributed to a post-COVID infection. The ill-health condition set in with severe pain, followed shortly by the onset of herpetic lesions. She experienced the symptoms while suffering from chronic fatigue syndrome. DIAGNOSES: A diagnosis of arthritis was made at the age of 60, and the patient has since been under treatment with analgesic therapy and prednisone. However, her doctor advised lowering the dose of her RA medications. At the age of 67, she developed herpes. She is currently on acyclovir and remains fully compliant with her medication. A simple skull magnetic resonance study depicted the absence of intracranial abnormality. Electromyography of normal muscles is silent at rest, without neuropathy. Cholesterol, sodium, chlorine, erythrocyte, and eosinophil were at the lower limit of normal, while lipase, phosphatase alkaline, and platelets were at the upper limit. INTERVENTIONS: An integrative approach was taken, combining pharmaceutical prescriptions for arthritis, herpes, and mood symptoms with unconventional complementary therapies. Oral food intake was initiated and well-tolerated; however, the patient's clinical condition did not improve with the current treatment. She is currently recovering at home on a regimen of vitamins, acyclovir, and analgesics. While she has shown clinical improvement, some complications have emerged. OUTCOMES: Diagnostic findings demonstrate that her health is not within normal limits, necessitating a daily regimen of prednisone, analgesic therapy, and hydroxyzine/losartan. This case highlights the importance of studying patients with RA. Risk factors for severe COVID-19 outcomes include older age and comorbidities. LESSONS: This case highlights the potential for COVID-19 infection or immunization to precipitate a flare of preexisting arthritis, causing severe lower limb manifestations and sacroiliitis (low back pain/sciatica) in older individuals receiving management for rheumatic disease. Immune abnormalities in patients treated with prednisone are elements in deciding the prescription and duration of this drug, and a neurological assessment is essential.