CUTANEOUS FINDINGS IN COVID-19 INFECTION – ADULT VERSUS CHILD
Keywords:
COVID-19, pandemic, viral exanthem, skin manifestations, erythematous rash
Abstract
COVID-19 is causing a rapidly expanding pandemic for over 2 years now, representing global concern. In the current COVID-19 outbreak that is affecting all countries, research did not focus on the cutaneous manifestations of the new coronavirus infection. However, over the past few weeks, some case reports have been published in the literature describing cutaneous manifestations in COVID-19 positive patients. Skin manifestations suggestive for coronavirus infection have been described: morbilliform rash, erythematous-purpuric coalescing macules, varicella-like vesicles, petechial rash, widespread urticaria, transient unilateral livedo reticularis, chilblains-like papules located at the acral level and peripheral cyanosis which can evolve with bullae up to dry gangrene. The timing of these varied eruptions in the disease course remains unclear, as do any potential associations between morphological subtypes with different COVID-19 associated syndromes, disease courses and/or outcomes. In addition to those described, there is an increased risk of developing adverse reactions to drugs recently introduced in patients treated for COVID-19, with the appearance of cutaneous manifestations in any stage of the disease. We report one case of coronavirus disease that had as primary symptoms erythematous rash associated with pyrexia.
References
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[2] C. Huang, Y. Wang, X. Li, L. Ren, J. Zhao, Y. Hu, L. Zhang, G. Fan, J. Xu, X. Gu, et al, ”Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”, Lancet, vol. 395, pp. 497-506, 2020.
[3] W.J. Guan, Z.Y. Ni, Y. Hu, W.H. Liang, C.Q. Ou, J.X. He, L. Liu, H. Shan, C.L. Lei, D.S.C. Hui, et al, ”China Medical Treatment Expert Group for Covid-19: Clinical Characteristics of Coronavirus Disease 2019 in China”, N Engl J Med vol. 382, pp. 1708-1720, 2020.
[4] K.J. Clerkin, J.A. Fried, J. Raikhelkar, G. Sayer, J.M. Griffin, A. Masoumi, S.S. Jain, D. Burkhoff, D. Kumaraiah, L. Rabbani, et al, ”Coronavirus disease 2019 (COVID-19) and cardiovascular disease”, Circulation, vol. 141, pp. 1648-1655, 2020.
[5] A.O. Docea, A. Tsatsakis, D. Albulescu, O. Cristea, O. Zlatian, M. Vinceti , S.A. Moschos, D. Tsoukalas, M. Goumenou, N. Drakoulis, et al, ”A new threat from an old enemy: Re emergence of coronavirus (Review)”, Int J Mol Med, vol. 45, pp. 1631-1643, 2020.
[6] D. Calina, A.O. Docea, D. Petrakis, A.M. Egorov, A.A. Ishmukhametov, A.G. Gabibov, M.I. Shtilman, R. Kostoff, F. Carvalho, M. Vinceti, et al, ”Towards effective COVID 19 vaccines: Updates, perspectives and challenges (Review)”, Int J Mol Med, vol. 46, pp. 3-16, 2020.
[7] C. Galván, A. Català, G. Carretero-Hernández, P. Rodríguez-Jiménez, D. Fernández-Nieto, L.A. Rodríguez-Villa, I. Navarro-Fernández, R. Ruiz-Villaverde, D. Falkenhain-López, M. Llamas-Velasco M, et al ”Classification of the cutaneous manifestations of COVID-19: A rapid prospective nationwide consensus study in Spain with 375 cases”, Br J Dermatol, vol. 183, pp. 71-77, 2020.
[8] B. Joob B, V. Wiwanitkit V, ”COVID-19 can present with a rash and be mistaken for dengue”, J Am Acad Dermatol, vol. 82, pp. 177, 2020.
[9] X.W. Xu, X.X. Wu, X.G. Jiang, K.J. Xu, L.J. Ying, C.L. Ma, S.B. Li, H.Y. Wang, S. Zhang, H.N, Gao, et al, ”Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: Retrospective case series”, BMJ, vol. 368, pp. 606, 2020.
[10] P.C. Robinson PC, J. Yazdany, ”The COVID-19 Global Rheumatology Alliance: Collecting data in a pandemic”, Nat Rev Rheumatol, vol. 16, pp. 293-294, 2020.
[11] M. Hunt, C. Koziatek, ”A case of COVID-19 pneumonia in a young male with full body rash as a presenting symptom” Clin Pract Cases Emerg Med, vol. 4, pp. 219-221, 2020.
[12] S. Recalcati, ”Cutaneous manifestations in COVID-19: A first perspective”, J Eur Acad Dermatol Venereol, Vol. 34, pp. 212-213, 2020.
[13] J.J. Zhang, X. Dong, Y.Y. Cao, Y.D. Yuan, Y.B. Yang, Y.Q. Yan, C.A. Akdis, Y.D. Gao, ”Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China” Allergy, pp. 14238, 2020.
[14] P. Mehta, D.F. McAuley, M. Brown, E. Sanchez, R.S. Tattersall, J.J. Manson, ”HLH Across Speciality Collaboration, UK: COVID-19: Consider cytokine storm syndromes and immunosuppression”, Lancet, vol. 395, pp. 1033-1034, 2020.
[15] C. Vajaitu, C.C. Draghici, I. Solomon, C.V. Lisievici, A.V. Popa, M. Lupu, C. Caruntu, M.M. Constantin, V.M. Voiculescu, ”The Central Role of Inflammation Associated with Checkpoint Inhibitor Treatments”, J Immunol Res, 2018.
[16] M.C. Dumitrașcu, A.M.A. Stănescu, C. Bejan, F. Șandru, D.O. Toader, G. O. Rădavoi, A. Cotirlet, et al, ”Obesity and its Implications on Stress Urinary Incontinence” Rev Chimia, vol. 70, pp. 3660-3662, 2019.
[17] J.M. Sanders, M.L. Monogue, T.Z Jodlowski, J.B. Cutrell, ”Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review”, JAMA, 2020.
[18] A. Patrì, G. Fabbrocini, ”Hydroxychloroquine and ivermectin: A synergistic combination for COVID-19 chemoprophylaxis and treatment?”, J Am Acad Dermatol, vol. 9622, no. 20, pp. 30557-30560.
[19] A.N. Sharma, N.A. Mesinkovska, T. Paravar, ”Characterizing the adverse dermatologic effects of hydroxychloroquine: a systematic review”, J Am Acad Dermatol, vol. 9622, no. 20, pp. 30564-30568.
[20] D. Andina, A. Belloni-Fortina, C. Bodemer, E. Bonifazi, A. Chiriac, I. Colmenero, A. Diociaiuti, M. El-Hachem, L. Fertitta, D. van Gysel, A. Hernández-Martín, T. Hubiche, C. Luca, L. Martos-Cabrera, A. Maruani, F. Mazzotta, A.D. Akkaya, M. Casals, J. Ferrando, R. Grimalt, I. Grozdev, V. Kinsler, M.A. Morren, M. Munisami, A. Nanda, M.P. Novoa , H. Ott, S. Pasmans, C. Salavastru, V. Zawar, A. Torrelo, ”ESPD Group for the Skin Manifestations of COVID-19. Skin manifestations of COVID-19 in children: Part 1”, Clin Exp Dermatol, vol. 46, no. 3, pp. 444-450, April 2021.
[21] J.A. Cappel, D.A. Wetter, ”Clinical characteristics, etiologic associations, laboratory findings, treatment, and proposal of diagnostic criteria of pernio (chilblains) in a series of 104 patients at Mayo Clinic, 2000 to 2011”, Mayo Clin Proc, vol. 89, no. 2, pp. 207-215, Feb 2014.
[22] M. Hughes, S. Rogers, G. Lepri, et al, ”Further evidence that chilblains are a cutaneous manifestation of COVID-19 infection” Br J Dermatol 2020; vol. 183, pp. 596-598.
[23] N. Kluger, J.N. Scrivener, ”The use of google trends for acral symptoms during COVID-19 outbreak in France”, J Eur Acad Dermatol Venereol, vol. 34, pp. 358-360, 2020.
[24] A. Alramthan, W. Aldaraji, ”Two cases of COVID-19 presenting with a clinical picture resembling chilblains: first report from the Middle East” Clin Exp Dermatol, vol. 45, pp. 746-748, 2020.
[25] J. Romaní, E. Baselga, O. Mitjà, et al, ”Chilblain and acral purpuric lesions in Spain during covid confinement: retrospective analysis of 12 cases”, Actas Dermosifiliogr, vol. 111, pp. 426-429, 2020.
[26] D. Andina, L. Noguera-Morel, M. Bascuas-Arribas, et al, ”Chilblains in children in the setting of COVID-19 pandemic”, Pediatr Dermatol, vol. 37, pp. 406-411, 2020.
[27] M. El Hachem, A. Diociaiuti, C. Concato, et al, ”A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection”, J Eur Acad Dermatol Venereol, vol. 35, pp. 201-204, 2020.
[28] G. Garcia-Lara, L. Linares-González, T. Ródenas-Herranz, R. Ruiz-Villaverde, ”Chilblain-like lesions in pediatrics dermatological outpatients during the COVID-19 outbreak”, Dermatol Ther, vol. 50, e-sub. 13516, 2020.
[29] E. E. Freeman, D.E. McMahon, J.B. Lipoff, et al, ”Pernio-like skin lesions associated with COVID-19: a case series of 318 patients from 8 countries”, J Am Acad Dermatol, vol.83, pp. 486-492, 2020.
[30] C. Galván-Casas, A. Català, G. Carretero-Hernández, et al, ”Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases”, Br J Dermatol, vol. 183, pp. 71-77, 2020.
[31] D. Andina, A. Belloni-Fortina, C. Bodemer, E. Bonifazi, A. Chiriac, I. Colmenero, A. Diociaiuti, M. El-Hachem, L. Fertitta, D. van Gysel, A. Hernández-Martín, T. Hubiche, C. Luca, L. Martos-Cabrera, A. Maruani, F. Mazzotta, A.D. Akkaya, M. Casals, J. Ferrando, R. Grimalt, I. Grozdev, V. Kinsler, M.A. Morren, M. Munisami, A. Nanda, M.P. Novoa, H. Ott, S. Pasmans, C. Salavastru, V. Zawar, A. Torrelo A, ”ESPD Group for the Skin Manifestations of COVID-19. Skin manifestations of COVID-19 in children: Part 2”, Clin Exp Dermatol, vol. 46, no. 3, pp. 451-461, Apr. 2021.
[32] J. Jimenez-Cauhe, D. Ortega-Quijano, I. Carretero-Barrio, et al, ”Erythema multiforme-like eruption in patients with COVID-19 infection: clinical and histological findings”, Clin Exp Dermatol, vol. 45, pp. 892-895, 2020.
[33] H. Janah, A. Zinebi, J. Elbenaye, ”Atypical erythema multiforme palmar plaques lesions due to SARS-CoV-2”, J Eur Acad Dermatol Venereol, vol. 34, pp. 373-375, 2020.
[34] A. Torrelo, D. Andina, C. Santonja, et al, ”Erythema multiforme-like lesions in children and COVID-19”, Pediatr Dermatol, vol. 37, pp. 442-446, 2020.
[35] P. Labé, A. Ly, C. Sin, et al, ”Erythema multiforme and Kawasaki disease associated with COVID-19 infection in children”, J Eur Acad Dermatol Venereol, vol. 34, pp. 539-541, 2020
[36] V. Piccolo, I. Neri, C. Filippeschi, et al, ”Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients”, J Eur Acad Dermatol Venereol, vol. 34, pp. 29-30, 2020.
[37] P. Gisondi, S. PIaserico, C. Bordin, et al, ”Cutaneous manifestations of SARS-CoV-2 infection: a clinical update”, J Eur Acad Dermatol Venereol, 2020.
[38] A.V. Marzano, G. Genovese, G. Fabbrocini G, et al, ”Varicella-like exanthema as a specific COVID-19-associated skin manifestation: multi-center case series of 22 patients”, J Am Acad Dermatol, vol. 83, pp. 280-285, 2020.
[39] V. De Giorgi, S. Recalcati, Z. Jia, et al, ”Cutaneous manifestations related to coronavirus disease 2019 (COVID-19): a prospective study from China and Italy”, J Am Acad Dermatol, vol. 83, pp. 674-675, 2020.
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Published
2022-01-06
How to Cite
Popa, A., Sandru, F., Simion, V., Al-shami, S., Mehedințu, C., Dumitrașcu, M., & Miulescu, R. (2022). CUTANEOUS FINDINGS IN COVID-19 INFECTION – ADULT VERSUS CHILD. Romanian Journal of Clinical Research, 5(1). https://doi.org/10.33695/rjcr.v5i1.82
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Articles
