A case report of monoarthritis in a covid-19 patient and literature review simple actions for complex times

Abstract

Rationale: COVID-19 presentation is multifaceted and up to 44% of patients affected by COVID-19 experience musculoskeletal complaints, mostly in the form of diffuse aspecific arthromyalgias. Nevertheless, only a few cases of arthritis following SARS-CoV2 infection are reported. Patient concerns: A 27-year-old man affected by nail psoriasis presented with monoarthritis 2 weeks after being diagnosed with COVID-19. Diagnoses: Diagnostic work-up and differential diagnosis were made difficult by patient isolation, absence of lab tests, and his visit via telemedicine, even though signs of first metacarpophalangeal joint involvement were clear. Interventions: Due to the inefficacy of acetaminophen and nonsteroidal anti-inflammatory drugs, the patient was prescribed oral steroids with a rapid benefit. Outcomes: The patient's response to oral steroid was prompt and maintained even after therapy tapering. Even so, a formal diagnosis was not possible due to a difficult diagnostic work-up and lack of a long-term follow-up. Lessons: Like many other viral diseases, SARS-CoV2 can play as a causative agent or as a trigger for inflammatory arthritis development in predisposed individuals. Abbreviations: CD4+ = cluster of differentiation 4 positive, CD8+ = cluster of differentiation 8 positive, CMV = cytomegalovirus, EBV = Epstein-Barr virus, GP = general practitioner, HIV = human immunodeficiency virus, HSP = heat shock protein, IL-17+ = interleukin 17 positive, IP = interphalangeal, MCH = major histocompatibility complex, MCP = metacarpophalangeal, MRI = magnetic resonance imaging, MTP = metatarsophalangeal, NSAIDs = nonsteroidal anti-inflammatory drugs, PsA = psoriatic arthritis, RA = rheumatoid arthritis, ReA = reactive arthritis, SpA = spondyloarthritis, TH17 = T helper 17, TLR = toll-like receptor, US = ultrasonography.