ABSTRACT
A 56-year-old woman presented for evaluation of a pruritic rash with associated body aches, fever, and chills that first appeared about 1 week after Johnson and Johnson COVID-19 vaccination. The rash initially presented as one lesion on her left breast that then spread to her face and groin. Based on clinical presentation, dermoscopic findings, and histopathological examination, a diagnosis of inverse pityriasis rosea was made. Although the exact pathogenesis of pityriasis rosea remains unknown, current evidence suggests that the inflammatory reaction to infectious agents, vaccines, certain drugs, or reactivation of herpesvirus 6 and 7 are possible etiologies.
ABSTRACT
As COVID-19 continues, there are new manifestations and less common presentations of this illness of which we need to be aware. This case describes a 44-year-old woman with a new-onset rash on her lower back and inner thighs. Based on a punch biopsy of both locations, either severe urticaria or early urticarial vasculitis was diagnosed. The patient recovered after treatment with a combination of oral steroids and high-dose antihistamines. Two days after the biopsy, she tested positive for SARS-CoV-2. The urticarial vasculitic reaction was likely secondary to infection from COVID-19 and was the initial presentation of the disease.
ABSTRACT
Establishing accurate symptomatology associated with novel diseases such as COVID-19 is a crucial component of early identification and screening. This case report identifies an adult patient with a history of clotting dysfunction presenting with rare cutaneous manifestations of COVID-19, known as 'COVID-19 toes'', previously described predominantly in children. Additionally, this patient presented with possible COVID-associated muscle spasticity of the lower limbs, as well as a prolonged and atypical timeline of COVID-19 infection. The rare occurrence of 'COVID-19 toes'' in this adult patient suggests that her medical history could have predisposed her to this symptom. This supports the coagulopathic hypothesis of this manifestation of COVID-19 and provides possible screening questions for patients with a similar history who might be exposed to the virus. Additionally, nervous system complaints associated with this disease are rare and understudied, so this novel symptom may also provide insight into this aspect of SARS-CoV-2.