Psoriatic Arthritis Flare in a Hospitalized Patient with Schizoaffective Disorder: A Case Report

Abstract

Psoriasis is a known comorbid condition in patients with schizophrenia spectrum disorders. Due to the nature of these psychiatric conditions, many experience lengthy hospitalizations and self-isolate at baseline, which can make identification and management of psoriasis difficult. We report the case of a middle-aged male with a history of schizoaffective disorder and treatment-resistant psoriatic arthritis who experienced a severe flare while hospitalized. His two-month hospital stay became complicated by combative behavior and continued medication refusal, resulting in repeated seclusion events and eventual transfer to a higher acuity unit. After treatment with ixekizumab and a course of prednisone was initiated one month after admission and symptom onset, the patient’s lesions were tremendously improved along with his mood on the unit. With the improvement in his chronic pain and discomfort, the patient was able to focus on mental health recovery and rapidly approached discharge. This report highlights the importance of appropriate management of comorbid conditions, especially psoriasis in patients with schizophrenia spectrum disorders needing long-term hospitalization. Additionally, this case demonstrates the successful use of ixekizumab in treatment-resistant psoriasis.