SARS-CoV-2 and guttate psoriasis: A case report and review o
Thirty years female from Nepal with no past medical history presented on March 2021 with a low-grade fever and mild cough. She was diagnosed with SARS-CoV-2 infection using fully automated reverse-transcription polymerase chain reaction (RT-PCR) from nasopharyngeal and throat swabs with CT 15.45. Chest X-ray was unremarkable apart from increased bronchovascular marking, and she was classified as mild SARS-CoV-2 disease according to the WHO case definition.8 She only received vitamin C tablets along with paracetamol during her SARS-CoV-2 infection. She recovered from fever and cough and tested negative 20 days later.

Two days after testing positive for SARS-CoV-2, she noticed a painful scaly rash that progressed to involve most of her skin (Figure 1). The rash was a widespread painful, itchy erythematous skin rash with significant scaling that mainly affects the trunk, the back, upper limbs, and scalp. The rash spares her face, palms, and soles. She first noticed a painless scattered slightly scaly rash with nail changes 6 months ago, which she did not seek medical attention. The lesions were stable until the presentation when she noticed a rapid progression of the rash.

There were no associated joint pain or swelling; she has no family history of similar conditions, and she did not use any topical creams other than Vaseline. Her vitals showed one episode of Fever spiking to 39 degrees, and blood pressure was on the lower borderline of 100–90 SBP with tachycardia in the range of 90–110 beats per minute. Bodyweight was 45 kg. On examining the patient, scaly, well-demarcated erythematous plaques were noticed over the trunk, limbs, scalp, and ears covering approximately 60% of body surface area. Mouth examination was unremarkable no erythema or congestion.

Skin punch biopsy from the abdomen revealed prominent regular acanthosis with elongated rete (psoriasiform hyperplasia), as well as surface hyperkeratosis and parakeratosis. The granular layer was lost. Foci of neutrophilic microabscesses were noted within the stratum corneum (Munro microabscesses). The superficial dermis displayed perivascular predominantly lymphocytic inflammatory infiltrate with scattered neutrophils. Deep dermis was unremarkable. Fungal stain was negative. Histologically, the appearances were in keeping with psoriasis.

She was admitted for 5 days during she received generous IV hydration and started on oral Cyclosporine 100 mg twice daily therapy (after SARS-CoV-2 was negative), along with oral minocycline, topical mometasone 1% cream with emollients. The renal function was stable. Her skin rash improved significantly, and she was discharged on cyclosporine and mometasone cream with dermatology follow-up.