Immunosuppressive and immunomodulatory treatments are critical for the management of inflammatory and autoimmune conditions such as psoriasis or psoriatic arthritis. Like in those illnesses, the lung injury and acute respiratory distress shown in COVID‐19 patients are the result of a disruption in the balance of pro‐ and anti‐inflammatory cytokines. This hyperinflammatory response to SARS‐CoV‐2, associated with the severity of the coronavirus disease, is called the cytokine storm. There is a growing concern regarding how patients on immunosuppressant biologic therapies might be at higher risk of being infected and whether they need to discontinue their treatment preemptively. Clinical data on COVID‐19 infected patients with psoriasis or psoriatic arthritis are still scarce. Here, we presented seven cases of this type of patients. The patient infected with COVID‐19 on apremilast and the one on apremilast with infected spouse showed the best safety profile and mildest symptoms. One of the secukinumab patients also presented a relatively good outcome. Infliximab patients and the one with serious comorbidities showed the worst outcome. Even though more clinical data are yet needed to draw strong conclusions, apremilast could be a safer alternative for dermatology and rheumatology patients in case of clinically important active infection.
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In patients with clinical features of longstanding PL and histological findings consistent with MF, differential diagnosis must include PL, LyP, and papular MF. As some forms of PL evolve towards MF and PL-like forms of MF, these patients should undergo regular follow-up and repeated biopsies in order to discard diagnoses of atypical forms of MF.
The recent outbreak of coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, has posed a great worldwide public health concern. Extraordinary and extensive measures to reduce virus transmission have been implemented in an increasing number of countries to control the disease rapid spread, including placing a country entire population in temporary selfquarantine and implementing strict social distancing protocols. As of March 28, the overall worldwide mortality rate of COVID-19 stays of about 4.6%, according to World Health Organization estimations.
Severe mononeuritis multiplex in systemic lupus erythematosus (SLE) is quite rare and almost always accompanied by evidence of active disease in other organs, although occasionally it may be the presenting feature of the disease. We describe here two patients with SLE who presented a severe mononeuritis multiplex secondary to a necrotizing vasculitis which respond successfully to therapy with intravenous cyclophosphamide, and review the literature of similar cases.
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