COVID-19 in a patient with Graves’ disease associated with rheumatoid arthritis: the 1st case

Abstract

INTRODUCTION: This article reports the first case of a patient with rheumatoid arthritis (RA) associated with Graves’ disease (GD) who evolved with COVID-19 infection. CASE DESCRIPTION: A 34-year-old male patient who was previously healthy was diagnosed with GD in 2018. After 6 months of GD diagnosis, he started polyarthritis associated with morning stiffness and reduced daily activities. He was treated with 20 m/day of prednisone and hydroxychloroquine 400 mg/day. Laboratory tests showed TSH of 0.09 mcg/mL, positive TRAb, C-reactive protein of 48 mg/L, and positive rheumatoid factor of 32 IU/mL. We initiated methotrexate 15 mg/week plus folic acid 5 mg/ week and reduced prednisone to 10 mg/day. He evolved with RA improvement. In February 2022, he started fever, anorexia, severe fatigue, and dry cough. He denied dyspnea. He was diagnosed with COVID-19 infection in the emergency room by rapid test. The patient became asymptomatic after seven days, and RA remained in low disease activity during the COVID-19 infection. CONCLUSIONS: It is the first case of a patient with GD who developed RA and COVID-19 described in the literature.

Keywords

• graves’ disease
• rheumatoid arthritis
• covid-19
• autoimmune disease
• autoimmunity