The aim of this Biologic Advisory Group (BAG) Malaysia consensus guideline is to provide clinicians managing cutaneous diseases with biologics relevant parameters to consider prior to initiating or stopping or continuing any biologic treatment in the current landscape of the COVID-19 pandemic. Besides reviewing the medical literatures on COVID-19 and evidences related to other human coronavirus or influenza, expert opinions and clinical experiences are shared and debated in formulation of this biologic consensus guideline.

Case summary A 62 year old gentleman was admitted to medical ward for 2 months history of generalized body weakness, anorexia, vague abdominal pain, fatigue and multiple erythematous, non-pruritic, scaly patches and plaques scattered throughout his body associated with nasal stuffiness. These lesions were hypoaesthetic. Blood investigations revealed a high corrected calcium level at 3.24 mmol/L which explained his acute medical complaints. Slit skin smear revealed Bacteriological Index (BI) of 1.2 and Morphological Index (MI) of 3.9. Skin biopsy confirmed the diagnosis of Borderline Lepromatous Leprosy. Institution of systemic steroids, vigorous intravenous fluid infusion and the implementation of multi-drug therapy for his leprosy resulted in a relatively swift decrease in reduction of calcium level. Conclusion This case report highlights the rare but important association of hypercalcaemia with leprosy. However, other granulomatous diseases such as sarcoidosis and tuberculosis have higher association with hypercalcaemia.