ABSTRACT
During the 2020 coronavirus (SARS-CoV-2) pandemic, several cutaneous lesions were identified, including pseudo-chilblain, vesicular, urticarial, maculopapular, and livedo/necrosis. A 59-year-old obese man with probable COVID-19 developed painful cyanosis with histopathologic capillary thrombosis of toes, and the cyanosis persisted for nearly 22 months. Shortly after initial exposure to family members with documented SARS-CoV-2, he developed upper respiratory symptoms, yet his anti-SARS-CoV-2 antibody and nasal swab RT-PCR tests were repeatedly negative. Two family members were hospitalized and one of them succumbed with documented SARS-CoV-2 pneumonia within 10 days of exposure. Biopsy specimen of the distal toe 16 weeks after initial exposure showed papillary dermal capillary thrombosis with endothelial swelling, telangiectasia, and peri-eccrine lymphocytic infiltrates resembling pernio. Overall, this is the first case of biopsy specimen of "long COVID toe" following presumed SARS-CoV-2 exposure, with a demonstration of thrombotic vasculopathy, toe cyanosis, and pernio-like pathology.
Subject(s)
COVID-19 , Cyanosis , Thrombosis , Toes , COVID-19/complications , COVID-19/pathology , Chilblains/pathology , Cyanosis/complications , Cyanosis/pathology , Humans , Male , Middle Aged , Obesity/complications , SARS-CoV-2/pathogenicity , Thrombosis/complications , Thrombosis/pathology , Time Factors , Toes/pathology , Post-Acute COVID-19 SyndromeABSTRACT
A growing number of skin lesions during the COVID-19 pandemic are being recognized. Acral ischemic lesions identical to chilblains are most typical in children and young adults. We report an infant girl, aged 1 month and 29 days, with a peculiar reticulated purpuric eruption on her soles, with positive immunohistochemistry for SARS-CoV-2 in the endothelia of dermal blood vessels. The patient had an excellent outcome without specific therapy.
Subject(s)
COVID-19/complications , Foot/blood supply , Purpura/virology , Female , Humans , Infant , SARS-CoV-2Subject(s)
Acantholysis/diagnosis , COVID-19/diagnosis , Ichthyosis/diagnosis , SARS-CoV-2/isolation & purification , Acantholysis/blood , Acantholysis/immunology , Acantholysis/pathology , Biopsy , COVID-19/complications , COVID-19/immunology , COVID-19/virology , COVID-19 Serological Testing , Dermoscopy , Diagnosis, Differential , Exanthema , Humans , Ichthyosis/blood , Ichthyosis/immunology , Ichthyosis/pathology , Male , Middle Aged , SARS-CoV-2/immunology , SARS-CoV-2/pathogenicity , Skin/diagnostic imaging , Skin/pathologyABSTRACT
During examination of cases of chilblains in children and adolescents, we identified four patients who also showed skin lesions similar to erythema multiforme (EM). They had no other known triggers for EM. One of them had a positive PCR for SARS-CoV-2, while the other three were negative. Skin biopsies from two patients showed features not typical of EM, such as deep perivascular and perieccrine infiltrate and absence of necrosis of keratinocytes. Immunohistochemistry for SARS-CoV/SARS-CoV-2 spike protein showed granular positivity in endothelial cells and epithelial cells of eccrine glands in both biopsies. All patients had an excellent outcome, and had minimal or no systemic symptoms. The coincidence of EM, a condition commonly related to viruses, and chilblains in the setting of COVID-19, and the positivity for SARS-CoV/SARS-CoV-2 spike protein by immunohistochemistry strongly suggest a link between EM-like lesions and SARS-CoV-2.