A case of COVID-19 with papulovesicular rash that progressed to retiform purpura, accompanied by cherry angiomas

ABSTRACT CONTEXT: Various skin manifestations have been reported in coronavirus disease. It may be difficult to determine the etiology of these lesions in view of the increased frequency of handwashing during the pandemic, along with occurrences of irritant contact dermatitis and allergic contact dermatitis due to disinfectant use; usage of herbal medicine and supplements to strengthen the immune system; and urticarial or maculopapular drug eruptions due to COVID-19 treatment. The variety of associated skin manifestations seen with COVID-19 makes it challenging to identify virus-specific skin manifestations. Petechiae, purpura, acrocyanosis and necrotic and non-necrotic purpura, which can be considered as manifestations of vascular involvement on the skin, have been reported. CASE REPORT: Here, we report a case of eruptive cherry angiomas, which was thought to have developed due to COVID-19, with a papulovesicular rash on distal extremities that progressed over time to reticular purpura. CONCLUSION: The case presented had a papulovesicular rash at the onset, which evolved to retiform purpura, and eruptive cherry angiomas were observed. It should be kept in mind that dermatological signs may vary in patients with COVID-19.

COVID-19 presenting as an exanthematic disease: a case report

Abstract Coronavirus disease (COVID-19) is caused by SARS-CoV-2 and has spread rapidly and caused a global pandemic. Knowledge about clinical and laboratory manifestations in the pediatric population is necessary to guide and monitor such patients. A 3-year-old female patient diagnosed with COVID-19 presented with high fever. After defervescence, she experienced a maculopapular rash that worsened by the sixth day of the disease with self-limited evolution without relevant laboratory changes. The identification of rashes in children with COVID-19 is an unusual and important condition that must be recognized in view of the high transmissibility shown.

The role of pregnant women with rash in the Zika virus sentinel surveillance

Abstract INTRODUCTION: The state of São Paulo has been monitoring cases of microcephaly and pregnant women presenting with acute rash, through CeVeSP. METHODS: This was a descriptive study focusing on pregnant women with rash and the outcome of their pregnancy, based on the notifications through the CeVeSP. RESULTS: During 2016, 2,209 cases of pregnant women with rash were reported and investigated. Of these, 36.6% were confirmed. Of the pregnant women who tested positive for ZIKV, 6.4% did not have a favorable outcome. CONCLUSIONS Our results allowed the characterization of pregnant women exposed to ZIKV and the outcome of pregnancy.

Resposta da representação da OPAS/OMS no Brasil para a epidemia do vírus da zika e suas consequências / Response representation of PAHO / WHO in Brazil for the zika virus epidemic and its consequences

A terceira edição do boletim sobre a epidemia do vírus zika e suas consequências apresenta as atividades realizadas pela Representação no Brasil da Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) de 10 a 16 de março de 2016. A publicação também resume informações epidemiológicas divulgadas pelo Ministério da Saúde e pelas Secretarias Estaduais de Saúde. Nesta semana, a OPAS realizou uma visita de campo a Pernambuco, estado que registrou o maior número de casos de microcefalia do país.

Herpes zoster-associated acute urinary retention in immunocompetent patient

Herpes zoster-associated urinary retention is an uncommon event related to virus infection of the S2-S4 dermatome. The possible major reasons are ipsilateral hemicystitis, neuritis-induced or myelitis-associated virus infection. We report a case of a 65-year-old immunocompetent female patient who presented an acute urinary retention after four days under treatment with valacyclovir for gluteal herpes zoster. The patient had to use a vesical catheter, was treated with antibiotics and corticosteroids and fully recovered after eight weeks.

Echovírus 6 associado à doença exantemática / Echovirus 6 associated with exanthematic disease

Exantema viral é considerado problema comum em regiões tropicais, afetando principalmente crianças. Diversos exantemas cutâneos estão associados a infecções por Enterovirus. Amostras biológicas provenientes de uma criança apresentando exantema generalizado foram enviadas ao Laboratório de Vírus Entéricos do Instituto Adolfo Lutz para a realização do diagnóstico laboratorial. Amostra viral isolada em RD (human rhabdomyosarcoma cells) foi submetida à reação em cadeia pela polimerase apresentando um produto de 437 pares de base, característico de gênero Enterovirus. O sorotipo echovirus 6 (E-6) foi identificado por ensaio de imunofluorescência indireta. Em adição, as amostras pareadas de soro apresentaram soroconversão para E-6. Até o momento, não há relatos do envolvimento de E-6 associado a doenças exantemáticas no Brasil, enfatizando a importância da vigilância epidemiológica para essas doenças e suas complicações.

Viral exanthems are a common problem in tropical regions, particularly affecting children. Various skin rashes have been reported in acute infections caused by Enterovirus. Biological samples from a child who presented generalized rashes were sent to the Enteric Virus Laboratory of the Adolfo Lutz Institute for laboratory diagnosis to be performed. A viral sample isolated from RD (human rhabdomyosarcoma cells) was subjected to the polymerase chain reaction and showed a 437-base pair product that was characteristic of the Enterovirus genus. Echovirus 6 (E-6) serotype was identified using the indirect immunofluorescence test. In addition, paired serum samples presented seroconversion to E-6. So far, there have not been any reports of E-6 involvement in exanthematic diseases in Brazil. Thus, the importance of epidemiological surveillance for these diseases and their complications is emphasized.

Manifestaciones purpúricas atípicas por parvovirus B19 en dos miembros de una familia: caso clínico / A family outbreak of parvovirus B19 atypical exanthemas: report of two cases

Two atypical cases of parvovirus B19 infection occurred consecutively within a family. A 14 year-old patient presented an extended papular-purpuric "gloves and socks" syndrome and two weeks later his mother developed a predominantly unilateral purpuric rash in the limbs with severe malaise. Specific IgM antibodies in the boy and polymerase chain reaction (PCR) and serology in the mother, confirmed parvovirus B19 infection. We emphasize the variable presentation of B19 infection within a family. The importance ofetiologic studies in the presence of atypical exanthemas and the utility of PCR in the diagnosis ofB19 are undesrscored.

Exantemas de la infancia / Childhood exanthems

En los últimos años han surgido algunos avances en el entendimiento de ciertos exantemas virales clásicos de la infancia, así como se ha relacionado algunos virus conocidos con exantemas atípicos y se han descrito nuevos exantemas probablemente vira les. Estos cuadros clínicos son parte de la consulta diaria y por ello requieren una revisión frecuente de los mismos.

Recent studies have introduced some progress in understanding of certain classic viral exanthems durig infancy: some well known viruses have been related with atypical exanthems, new exanthems, probably related with virus, have been described. These clinical pictures are quite common in daily practice and need to be frequently reviewed.

Etiologia de exantema em crianças em uma área endêmica de dengue / Etiology of exanthema in children in a dengue endemic area

OBJETIVO: Estudar a etiologia dos casos de exantema com ou sem febre em crianças atendidas no pronto-socorro de um hospital de uma zona endêmica para dengue. MÉTODOS: No período de 21/09/2001 a 20/09/2002, foram inscritas no estudo 95,9 por cento (71/74) das crianças atendidas no pronto-socorro do Hospital Universitário de Campo Grande (MS) que apresentassem exantema (percentual de recusa de 4,1 por cento). Após preenchimento do protocolo com os dados das crianças, as mesmas foram submetidas a exame físico seguido da coleta de amostras de sangue para realizar hemograma com contagem de plaquetas e sorologias (IgM e IgG); inicialmente para dengue, rubéola e toxoplasmose e, posteriormente, naqueles casos com resultado negativo, realizou-se sorologia para parvovirose, herpes vírus tipo 6 e sarampo. RESULTADOS: O diagnóstico laboratorial foi confirmado através da pesquisa de anticorpo IgM em 88,7 por cento dos casos investigados: dengue (77,5 por cento), herpes vírus tipo 6 (8,4 por cento), parvovirose (2,8 por cento) e diagnóstico inconclusivo em oito pacientes (11,3 por cento). Não foi evidenciada sorologia positiva (IgM) para sarampo, rubéola ou toxoplasmose naquela ocasião. As manifestações clínicas mais freqüentes nos pacientes com dengue foram: febre, prurido, prostração, mialgia e prova do laço positiva. Nos pacientes cujo diagnóstico foi dengue, a prova do laço foi positiva em 58,4 por cento (32/55) dos casos, demonstrando diferença estatisticamente significativa quando comparada com o grupo cujo diagnóstico não foi dengue. CONCLUSÕES: Nas crianças com exantema, dengue pode ser a principal enfermidade causal, atentando-se para a epidemiologia do local. É necessário um controle constante da vigilância epidemiológica e sorológica das doenças exantemáticas.

OBJECTIVE: To study the etiology of exanthema cases, with or without fever, in children seen in the emergency room of a hospital located in a region where dengue is endemic. METHODS: Enrollment took place between 21/09/2001 and 20/09/2002 and included 95.9 percent (71/74) of children presenting with exanthema at the emergency room of the Hospital Universitário de Campo Grande, MS (4.1 percent refusals). After the children had had their details taken and entered on the study protocol, they were subjected to physical examination followed by collection of blood samples for blood testing with platelet counts and serology (IgM and IgG); initially for dengue, rubella and toxoplasmosis and then, in negative cases, serology was also run for parvovirus, herpes virus type 6 and measles. RESULTS: Laboratory diagnoses were confirmed by means of IgM antibody assay in 88.7 percent of the cases investigated: dengue (77.5 percent), herpes virus type 6 (8.4 percent), parvovirus (2.8 percent) and in eight patients diagnosis was inconclusive (11.3 percent). On this occasion no positive serology (IgM) was observed for measles, rubella or toxoplasmosis. The most common clinical manifestations among the dengue patients were: fever, itching, prostration, myalgia and positive tourniquet test results. In 58.4 percent (32/55) of those cases diagnosed with dengue, the tourniquet test was positive, which was a statistically significant difference when compared with the remainder of the sample. CONCLUSIONS: When children present with exanthema, it is possible that dengue is the primary causative disease, depending on the epidemiology of the location. Constant control of epidemiological and serological surveillance of exanthematous diseases is necessary.

Parvovirus B19 infections in state of Rio de Janeiro, Brasil: 526 sera analyzed by IgM-enzyme-linked immunosorbent assay and polymerase chain reaction

In this study were analyzed 526 sera; the patients aged from two days to 65 years old presenting exanthema, which was the most frequent symptom observed, besides fever, adenomegaly, and arthralgia. These sera were negative by enzyme-linked immunosorbent assay (IgM-ELISA) for either rubella (495), toxoplasma (41), cytomegalovirus (12), measles (40), dengue (56), and they were submitted to nested polymerase chain reaction (PCR) for B19 DNA and commercial IgM-ELISA for B19. In 39 abortion cases, IgM or DNA were not detected, therefore they were not took into account for analysis. Specific DNA and IgM were detected respectively in 71 (14.5 percent) and IgM in 62 (12.7 percent) sera from 487 sera analyzed. IgM and DNA were simultaneously detected in 43 (8.8 percent), while agreement among the results by PCR and IgM-ELISA was observed in 440 (90.4 percent). The sera were collected from January 1999 to December 2000, most of them in 1999 (325), during winter and spring. The major number of clinical cases was observed in the age group from one to ten years old. IgM or DNA were detected in 23 from 51 municipal districts of the state of Rio de Janeiro, where the samples were collected.

Presença de parvovírus B19 em Manaus, AM / Occurrence of parvovirus B19 in Manaus, AM

A investigação de 1.107 casos de doenças exantemáticas em Manaus permitiu a identificação dos primeiros 47 casos de parvovírus humano B19 na cidade. O parvovírus B19 foi caracterizado por uma combinação de sinais e sintomas como febre, cefaléia, artralgia, mialgia e exantema. A freqüência de exantema foi maior em indivíduos menores de quinze anos e, no adulto, prevaleceram a febre e artropatias. O maior número de casos foi registrado em 1999. Quanto à faixa etária, nos menores de 15 anos, predominou o sexo masculino e, entre os adultos, o feminino. Este estudo, portanto, ressalta a necessidade de se elucidar a causa de doenças exantemáticas que ocorrem no Estado do Amazonas e indica que estudos são necessários, no que concerne à atividade viral.

Diagnóstico etiológico de pacientes con exantemas o cuadros febriles atendidos en 1998. Estado Zulia, Venezuela / Laboratory diagnosis of patients with exanthematic or febrile syndromes occurring in the Zulia State, Venezuela, during 1998

BACKGROUND: Exanthematic diseases are a group of syndromes mainly caused by acute viral infections. AIM: To obtain information about the viruses that cause exanthematic diseases in our region. PATIENTS AND METHODS: During 1998, 267 serum samples from patients with an acute rash or patients presenting a febrile syndrome accompanied by enlarged lymph nodes, headache and other symptoms, were collected. Specific antibody of the IgM class (anti-IgM) against Rubella, Measles, Dengue types 1-4 and Cytomegalovirus (CMV) were measured by immunoenzymatic assay (EIA). Epstein-Barr virus (EBV) antibodies were measured by immunofluorescence. RESULTS: An etiologic agent was detected in 208 cases (77.9%). Cases due to Dengue (40.6%) and Rubella (21%) viruses predominated, but the frequency of other agents was also high in specific age groups. The agreement between the clinical suspicion and the laboratory findings varied broadly, from a 100% for suspected Dengue to just a 14.8% for cases of suspected CMV infection. CONCLUSIONS: Dengue was the most common viral exanthematic disease in the Zulia State during 1998.