Exacerbation of Psoriasis Following COVID-19 Vaccination: Report From a Single Center

The temporal association had been reported between vaccination and exacerbation of psoriasis, and episodes of psoriasis flare-up have recently been attributed to COVID-19 vaccines. We recruited 32 unimmunized controls and 51 vaccinated psoriasis patients, 49 of whom were under biological therapy, with regular clinic visits receiving a total of 63 shots of vaccines, including 30 doses of Moderna mRNA-1273 and 33 doses of AstraZeneca-Oxford AZD1222. Fifteen episodes of exacerbation attacked within 9.3 ± 4.3 days, which is higher than two episodes in the control group (p = 0.047). The mean post-vaccination severity of the worsening episodes increased from PASI 3.1 to 8.0 (p < 0.001). Three patients showed morphologic change from chronic plaque-type to guttate psoriasis. Deterioration of psoriasis following COVID-19 vaccination was not associated with age, sex, disease duration, psoriatic arthritis, family history of psoriasis, history of erythroderma, current biologics use, comorbidities, vaccine types, human leukocyte antigen (HLA)-C genotypes, baseline PASI nor pre-vaccination PASI. For those who received two doses of vaccination, all but one patient aggravated after the first shot but not the second. The mechanism of psoriasis exacerbation in immunized individuals is unclear, but Th17 cells induced by COVID-19 vaccines may play a role. In the pandemic era, psoriasis patients and physicians should acknowledge the possibility of fluctuation of disease activity when vaccinated against COVID-19. Nevertheless, compared to a treatable dermatologic disease with rapid resolution of exacerbation, psoriasis patients who do not have contraindications to vaccination should benefit from COVID-19 vaccines in the prevention of severe COVID-19 infection and fatality.

Characteristics and Outcomes of Endogenous Endophthalmitis in Patients with Long-term Steroid Use

Purpose: To investigate the clinical characteristics and treatment outcomes of endogenous endophthalmitis (EE) in patients with a history of long-term oral corticosteroid (LTOC) use.Methods: This study was a retrospective review of the medical records of 17 patients (20 eyes) who were diagnosed and treated for EE from LTOC use from March 2004 to December 2019.Results: The mean age of the patients was 70.0 years, and 58.8% were men. Bilateral involvement was observed in three patients (17.6%). Predisposing medical conditions for steroid use were arthritis (6, 35.3%), renal disease (5, 29.4%), lung disease (5, 29.4%), and dermatologic disease (1, 5.9%). The most common causative agents were Gram-positive organisms (60.0%). All patients were treated with systemic antibiotics and vitreous tapping with intravitreal antibiotics or antifungal injection. Pars plana vitrectomy with intravitreal injection of antibiotics was performed in 11 eyes (55.0%). The initial best-corrected visual acuity (BCVA) of 20 eyes was 1.83 ± 0.79 and final BCVA was 0.70 ± 0.98 (p < 0.001). We analyzed the correlation between final visual acuity and initial visual acuity, causative organisms, sepsis, and vitrectomy. The results indicated a poor visual acuity prognosis for the patient group with sepsis.Conclusions: Our study revealed that LTOCs can induce EE. Gram-positive bacteria were the most common causative organisms of EE from LTOC use. The patient group with sepsis showed a worse visual acuity prognosis than the other groups.

Hepatic steatosis as measured by the computed attenuation parameter predicts fibrosis in long-term methotrexate use

Introduction: To determine predictors of hepatic steatosis by the computed attenuation parameter (CAP) and fibrosis via transient elastography (TE) in persons on methotrexate (MTX) therapy with rheumatologic and dermatologic diseases. Methods: A single-centred retrospective cohort study was performed. Patients on >6 months of MTX for a rheumatologic or dermatologic disease who had undergone TE from January 2015 to September 2019 were included. Multivariate analysis was performed to determine predictors of steatosis and fibrosis. Results: A total of 172 patients on methotrexate were included. Psoriasis was the most frequent diagnosis ( n = 55), followed by rheumatoid arthritis ( n = 45) and psoriatic arthritis ( n = 34). Steatosis (CAP ≥245 dB/m) was present in 69.8% of patients. Multivariate regression analysis revealed that diabetes mellitus (OR 10.47, 95% CI 1.42–75.35), hypertension (OR 5.15, 95% CI 1.75–15.38), and BMI ≥30 kg/m2 (OR 16.47, 95% CI 5.56–45.56) were predictors of steatosis (CAP ≥245 dB/m). Predictors of moderate to severe fibrosis (Metavir ≥F2 = TE ≥8.0kPa) by multivariate regression analysis included moderate to severe steatosis (CAP ≥270 dB/m) (OR 8.36, 95% CI 1.88–37.14), diabetes mellitus (OR 2.85, 95% CI 1.09–7.48), hypertension (OR 5.4, 95% CI 2.23–13.00), dyslipidemia (OR 3.71, 95% CI 1.50–9.18), and moderate alcohol use (OR 3.06, 95% CI 1.2–7.49). Conclusions: In patients on MTX for rheumatologic and dermatologic diseases, hepatic steatosis as measured by CAP was common and moderate to severe steatosis predicted moderate to severe fibrosis.

Elevated Glucagon in a Patient with Necrolytic Acral Erythema: A Case Report and Review of the Literature

Necrolytic acral erythema (NAE) is a relatively newly described dermatologic disease that is often associated with hepatitis C virus (HCV). Oral zinc therapy is a successful treatment; however, therapy is often delayed due to misdiagnosis. There are limited reports of NAE in the literature. This paper presents a case of NAE in a 68-year-old male with untreated HCV, whose NAE was diagnosed and treated as recurrent cellulitis for 12 years. He had low serum zinc and elevated serum glucagon levels. Elevated glucagon is not often reported in NAE, but the patient’s CT abdomen was negative, ruling out glucagonoma and necrolytic migratory erythema. He improved with oral zinc replacement and was referred to the hepatology department for HCV treatment. This paper additionally presents a review of the literature for NAE cases.