New-Onset Psoriatic Arthritis Following COVID-19 mRNA Vaccination in a Psoriatic Patient Under Anti-tumor Necrosis Factor Alpha Biologic Treatment: What Now?

During the COVID-19 pandemic, anti-SARS-CoV-2 vaccines were quickly developed and administered to the population worldwide. As is expected with new vaccine products, adverse reactions following immunization have been reported, namely, the development and/or exacerbation of autoimmune/autoinflammatory diseases, including rheumatic diseases. Here, we report a clinical case of a 56-year-old woman with a 44-year history of moderate-to-severe plaque psoriasis under treatment with an anti-tumor necrosis factor alpha biosimilar (adalimumab) with good control of skin disease and without rheumatic involvement to date who came to us with complaints of migratory polyarthralgia starting one week after receiving the second dose of the BNT162b2 COVID-19 mRNA vaccine. The condition progressed over the following months and a diagnosis of psoriatic arthritis was established. Biologic treatment was switched to an anti-interleukin 17A (secukinumab), with a very good clinical cutaneous and articular response, which was sustained up to the present moment. The mechanisms behind the exacerbation or new-onset of autoimmune/autoinflammatory diseases after receiving anti-COVID-19 vaccines are not yet fully understood, requiring further investigation. It is also not known whether rheumatic symptoms post-COVID-19 infection will have similar mechanisms to rheumatic symptoms post-anti-COVID-19 vaccination. With the continuing worldwide vaccination against SARS-CoV-2, clinicians need to be prepared to discuss the risks and benefits of vaccination and should be aware that it may cause or exacerbate immune disorders such as psoriatic arthritis, warranting close follow-up in terms of disease progression and treatment.

Basaloid Squamous Cell Carcinoma, an Aggressive and Rare Cancer of the Oral Cavity: Can We Prevent It at the Primary Care Setting?

Oral cavity cancer represents about 2%-3% of all cancers worldwide, with more than 355,000 new cases per year, one-third of which are reported in developed countries. Oral cancer is also known to be extremely aggressive when detected late, thus presenting one of the lowest cancer survival rates. It is estimated that as much as 90% of oral cancers are attributable to tobacco and/or alcohol consumption and that high-risk human papillomaviruses (HPV) infections pose an independently increased risk for their development. Therefore, it can be a preventable disease when associated with changes in lifestyle and possible modifiable risk factors, combined with early and preventive intervention. Basaloid squamous cell carcinoma (BSCC) constitutes an aggressive and rare form of oral cancer, being one of the rarest and most aggressive variants of squamous cell carcinoma (SCC, the most common), and usually presents as a high-grade disease with a poor prognosis. It is typically associated with heavy smoking and alcohol abuse, occurring most commonly in older men. Here, we report a clinical case of a 60-year-old man with excessive consumption of both tobacco and alcohol, poor oral hygiene, and partial edentulousness who came to our primary health department with complaints of odynophagia twice in a four-year time-lapse. The first time, two whitish ulcerated lesions on the left tonsil were detected and biopsied but revealed a negative histological result. After four years, he came again to our primary health care department with similar complaints of odynophagia and also sore throat with radiation to the right ear, accompanied by globus sensation and anorexia. No suspicious lesions were detected, except a globally hyperemic oropharynx. Considering the history of abusive consumption, no improvement with symptomatic treatment, and persistent clinical signs, an extended diagnostic approach was carried out. After four months, a pharyngeal mass measuring 53 mm was detected on pharyngeal-neck computed tomography (CT), and the diagnosis of a BSCC located in the right tonsillar pillar and base of the tongue was finally determined. Unlike other cancers that have been detected earlier through screening programs, oral cancer is often detected at an advanced stage, compromising survival and quality of life. The opportunity to intervene early and preventively in consumption habits, promote healthy lifestyles, and try to prevent disease is unique at the primary care level. Moreover, opportunistic screening through a thorough examination of the oral cavity is extremely important for timely diagnosis and treatment.