Concurrent psoriatic arthritis and autoimmune hepatitis in a patient with psoriasis: a case report

Psoriasis is a chronic, autoimmune skin disorder that can be associated with systemic comorbidities, including psoriatic arthritis (PsA). The coexistence of psoriasis, PsA, and autoimmune hepatitis (AIH) is uncommon and may present diagnostic and therapeutic challenges. This case report highlights a patient with psoriasis who developed both PsA and AIH without prior immunosuppressive therapy.

A 57-year-old Palestinian woman with longstanding plaque psoriasis presented with worsening skin lesions, progressive arthralgia involving both knees and ankles, chronic inflammatory low back pain, and persistently abnormal liver biochemistry. She had been diagnosed with psoriasis at age 49, which had been resistant to various treatments, including topical corticosteroids and phototherapy. One year before presentation, the patient developed progressive arthralgia, particularly in the knees, ankles, and lower back. Physical examination revealed swollen joints and limited range of motion. Laboratory tests indicated elevated liver enzymes, and autoimmune panel results were positive for antinuclear antibodies (ANA) and anti-smooth muscle antibodies (ASMA), raising suspicion for autoimmune hepatitis. A liver biopsy confirmed type 1 AIH, characterized by lymphocytic infiltration and plasma cell predominance. Cyclosporine 100 mg daily was initiated, atorvastatin was discontinued, and the patient was monitored clinically and biochemically. After 6 weeks, psoriasis severity improved markedly, joint symptoms decreased, and liver enzyme levels normalized. No treatment-related adverse effects were documented during the reported follow-up period.

This case highlights the importance of considering autoimmune hepatitis in patients with psoriatic disease who develop persistent liver enzyme abnormalities, even in the absence of prior systemic immunosuppressive therapy. A multidisciplinary approach is important in such complex presentations, and cyclosporine may be a useful therapeutic option in selected patients requiring concomitant control of dermatologic, rheumatologic, and hepatic disease.