Rashes caused by arbidol in a patient with novel coronavirus pneumonia.

A 50-year-old male patient with agitated depression and hyperlipemia received oral amoxicillin and clavulanate potassium 0.5 g once daily and 2 lopinavir and ritonavir tablets twice daily for novel coronavirus infection, based on previous drugs including quetiapine, clonazepam, and atorvastatin calcium. After 3 days, lopinavir and ritonavir was changed to oral arbidol 200 mg, thrice daily due to suspicious drug interaction. After taking arbidol for 3 days, the patient developed red papules on the whole body. Considering that it might be related to amoxicillin and clavulanate potassium, the drug was stopped and loratadine was given. But the rashes were aggravated. Considering that the drug eruption was caused by arbidol, arbidol was discontinued and the rashes subsided in a large area the next day. Then vitamin C injection, calcium gluconate injection, and ribavirin were added. After 5 days, the rashes subsided completely. After 17 days, the patient recovered from pneumonia.Copyright © 2020 by the Chinese Medical Association.

Multisystem inflammatory syndrome in children

Multisystem inflammatory syndrome in children (MIS-C) is a rare, but serious and potentially life-threatening hyperinflammatory complication of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It typically occurs 2-6weeks after primary infection, which is often mild or asymptomatic. The main symptoms are fever, gastrointestinal symptoms, variable rash, conjunctivitis, mucous membrane, and heart involvement. The differential diagnosis is very broad and includes many other causes of fever such as Kawasaki disease, acute COVID-19, bacterial sepsis, staphylococcal and streptococcal toxic shock syndrome, and gastrointestinal infections. Treatment of MIS-C requires a multidisciplinary approach and early immunomodulatory treatment to stop the hyperinflammatory response. Patients receive high doses of intravenous immune globulins and systemic glucocorticoids. Biologic drugs directed against IL-1 or IL-6 are required in patients with refractory or more severe diseases. With immediate treatment, the prognosis is generally good and cardiac function usually returns to normal. © 2023 Elsevier Inc. All rights reserved.

COVID arm as a common cutaneous manifestation after mRNA-1273 vaccination: a systematic review.

BACKGROUND: By August 2022, CoronaVirus Disease-2019 (COVID-19) had caused 600 million illnesses and 6.5 million fatalities globally. A massive vaccination program is being implemented worldwide to suppress this condition. Several works of literature stated that mRNA COVID-19 vaccination, specifically with the mRNA-1273 vaccine, is followed by clear evidence of the COVID arm effects associated with this vaccine. OBJECTIVE: To analyze the latest evidence of COVID arm as a common effect of mRNA-1273 vaccination with the ultimate goal of improving vaccine counseling to help healthcare professionals and reassure patients. METHODS: A comprehensive search was performed on topics that assess the COVID arm as a cutaneous manifestation following mRNA-1273 vaccination from inception up until July 2022. RESULTS: Eighteen studies with a total of 1129 participants after the first and second dose of mRNA-1273 vaccination reported that most participants had COVID arm following the first dose administration. The characteristics of the patients were a mean age of 43.8 years old, and females represented ≥ 50% in most studies, with a mean onset of 6.9 days after the first dose administration. Symptoms resolved within seven days following the treatment and were harmless. CONCLUSIONS: This study found that the COVID arm condition is most common following the first mRNA-1273 vaccination in the female and middle-aged group. The correlation between demographic variables and COVID arm risk elucidates that the reaction is a type IV allergic skin reaction.

Monkeypox Disease: An Emerging Public Health Concern in the Shadow of COVID-19 Pandemic: An Update.

The last few decades have witnessed an appalling rise in several emerging and re-emerging viral and zoonotic outbreaks. Such outbreaks are a lesson to learn from and seek insight into better disease monitoring and surveillance, thus preventing future outbreaks. Monkeypox, a viral zoonotic illness caused by the monkeypox virus, may no longer be endemic to the tropical rainforests of Central and West Africa. However, the current monkeypox outbreak in nonendemic countries is most likely due to failure to curb the disease dissemination in endemic African regions despite decades of constant outbreaks. The clinical manifestations are typified by a prodromal phase (fever, myalgia, malaise, and lymphadenopathy) followed by maculopapular or vesicular, or pustular cutaneous eruptions that eventually form encrustations and peel off. Children and the elderly, pregnant females, and individuals living with comorbidities (diabetes, HIV/AIDS, and lymphoproliferative ailments) are at a high risk of severe disease. Monkeypox is a self-limiting disorder, but its complications and pandemic potential signify its immense public health relevance. The recent ongoing monkeypox outbreak in nonendemic nations areas was identified with increased propensity in men who have sex with men (MSMs) with no travel history to endemic regions, emphasizing the changing trends in disease transmission. This review article provides an updated overview of the monkeypox disease taxonomy, pathogenesis, transmission, epidemiology, clinical and oral features, diagnostic aids, differential diagnosis, preventive aspects, and treatment protocol.

Allergic Skin Rash Caused by Iguratimod: A Report of Two Cases.

Iguratimod has been used in the treatment of rheumatoid arthritis and Sjogren's syndrome (SS). Herein, we report two cases of skin allergic reactions caused by iguratimod in our hospital. Case 1 was a woman with SS who developed diffuse pruritus erythema after three weeks of combination therapy of hydroxychloroquine (HCQ) and iguratimod. When the patient was again prescribed iguratimod after the rash subsided, the pruritus erythema reappeared. Case 2 was a 23-year-old girl treated with prednisone, HCQ, and mycophenolate mofetil for systemic lupus erythematosus and SS. In the follow-up treatment, mycophenolate mofetil was replaced by iguratimod. On the 20th day of treatment, a pruritic erythematous maculopapular rash appeared. To the best of our knowledge, this is the first study to report the characteristics of an allergic rash caused by iguratimod. It is better to administer HCQ and iguratimod successively rather than simultaneously to a patient.

ATYPICAL PRESENTATION OF COVID-19 IN AN ADOLESCENT RENAL TRANSPLANT RECIPIENT

Towards the end of 2019, a new coronavirus (CoV) was described emerging from Wuhan, China. Given its phylogenetic similarity to SARS-CoV, the new coronavirus was named severe-acute respiratory syndrome virus-2 and the disease it caused was named coronavirus disease of 2019 (COVID-19). There are few reports of paediatric renal transplant recipients infected with SARS-CoV-2 and, although guidelines for the management of solid-organ transplant recipients exposed to SAR-CoV-2 have been published, there are few paediatric-specific guidelines. We present a case of an unusual presentation of COVID-19 in an adolescent transplant recipient who presented with transient facial angioedema and a non-specific skin rash. She developed acute kidney injury, which resolved without any intervention. We suggest that, in future, an international registry of paediatric transplant recipients infected with COVID-19 be established to delineate more clearly the presenting features, clinical course and challenges encountered in treating these patients. © 2021, Allergy Society of South Africa. All rights reserved.

Isolated skin rash in patient with Coronavirus Disease 2019: A case report of skin manifestation in COVID-19 Virus Disease Isolated skin rash in patient with Coronavirus Disease 2019

BACKGROUND: Coronavirus Disease 2019 was initially identified as an infection of the lower respiratory tract, but has so far manifested itself with very different symptoms. One of these symptoms is skin lesions associated with active viral infection that can occur from the onset of infection until treatment. Therefore, observing these skin manifestations can be helpful to diagnose and manage the disease. CASE REPORT: Our case is a 56-year-old man who came to the infectious clinic with chief complain of skin rashes. The patient was in good general condition on arrival and had no evidence of systemic symptoms of infection, such as fever, body aches, and cough. However, the PCR test for COVID-19 was positive. CONCLUTION: Although many dermatological findings have been reported with Coronavirus Disease, but this case has reported with no symptoms other than skin manifestations that describe a viral infection. It seems that this disease can cause unexpected symptoms even in mild cases. Therefore, it is better to have the COVID-19 in the corner of your mind when examining people with these symptoms.

Delayed-type hypersensitivity skin reaction to Covid-19 vaccine.

Delayed-Type Hypersensitivity Skin Reaction following the Moderna mRNA COVID-19 Vaccine. This case is an unusually prolonged presentation of skin rash following vaccination for the novel COVID-19 virus. This case is clinically significant as it highlights an uncommon but not contraindicated potential side effect and details appropriate medical management. This case highlights that while potentially distressing patients who experience this side effect should be offered reassurance and conservative treatment.

Ocular Surface Erosion after Suspected Exposure to Evaporated COVID-19 Vaccine.

The purpose is to report ocular surface erosion of health personnel who were exposed to evaporated CoronaVac during a vaccination campaign. A campaign for CoronaVac vaccination was conducted in a closed space of 11.04 × 5.96 m, partially divided into 6 rooms with interconnected area among the rooms. A total of 20 health personnel worked in the vaccination rooms. On the third day of campaign, a vial, containing a single dose of 0.5 mL, of the vaccine was dropped accidentally onto the floor and broken by an administering nurse. A total of 15 personnel had symptoms and signs of ocular surface erosion at the average time from the accident to the onset of 10.2 ± 7.1 h; 4 personnel also had skin rash. These personnel included all 13 persons who already worked in the rooms when the accident occurred and continued for additional 4-6 h and 2 personnel who presented in the rooms 1-2 h after the accident and stayed for 2-3 h. Proximity and timing suggest CoronaVac correlation with the ocular and skin reactions. Cautions should be taken to avoid broken vials, spills, and aerosolization of CoronaVac during the vaccination.

The Third Wave of the COVID-19 Arrived in Afghanistan: A Severe Case with Skin Manifestation.

The COVID-19 is an ongoing global pandemic that has put the world in a devastating situation. The virus is able to attack multiple body systems and cause a variety of clinical problems ranging from asymptomatic to critical cases. Although young individuals are more likely to suffer milder forms of the disease, critical cases also might happen. Recent literature has revealed that, along with other clinical symptoms, skin manifestations have also progressively grown. In Afghanistan where COVID-19 has entered into a third wave, many people do not take the initial mild symptoms seriously to prevent further spreading in the community. We report symptoms of skin rash, fatigue, muscle pain, dry cough and fever at the onset of the disease, followed by rapid lung damage in a 23-year-old young adult, who did not have any preexisting risk factors. This case highlights the importance of urgent skin assessment of the COVID-19 patient complaining of any skin symptoms.

Pediatric COVID-19 infection in Sulaimaniyah Governorate, Iraq.

BACKGROUND: COVID-19 is a severe acute respiratory syndrome caused by SARS-CoV-2. OBJECTIVE: To study the demographic and clinical presentations of COVID-19 with their types including MIS-C and Kawasaki among children who were admitted to Doctor Jamal Ahmad Rashid Pediatric Teaching Hospital (DJARPTH) at Sulaimaniyah city, Iraq. PATIENTS AND METHODS: A prospective cohort study was conducted from June to December 2020 in which 50 cases suspected of COVID-19 were enrolled in the study that was admitted at the first visit to the emergency department of DJARPTH and their age ranged between 3 months to 14 years. Then, the collected data were divided into 3 groups: COVID-19, Kawasaki disease (KD), and MIS-C. RESULTS: The fever was the most common presented symptom in all cases with COVID-19 regardless of the severity. COVID-19 may be presented as KD as well as MIS-C. There is an increase in the number of Kawasaki cases since 2019 by 6.7 fold due to the increased number of COVID-19 cases in children. Death was more related to MIS-C and primary COVID-19 diseases. Most COVID-19 cases presented with pericardial effusion; although coronary involvement and LV dysfunction mostly seen with MIS-C cases. CONCLUSION: COVID-19 is not uncommon in pediatric patients and it presents as either primary, MIS-C, and KD. Most of the deaths and ICU outcomes were related to MIS-C presentations.

COVID-19 in a case with Kikuchi-Fujimoto disease.

The accurate diagnosis of Kikuchi-Fujimoto disease can protect children from unnecessary diagnostic procedures and treatments. Also, the co-occurrence of rare diseases with other diseases can improve or worsen the symptoms of the patients.

Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review.

There have been increasing reports of skin manifestations in COVID-19 patients. We conducted a systematic review and included manuscripts describing patients with positive RT-PCR coronavirus testing from nasopharyngeal swabs who also developed cutaneous manifestations. A total of 655 patients were selected, with different types of skin rashes: Erythematous maculopapular (n = 250), vascular (n = 146), vesicular (n = 99), urticarial (n = 98), erythema multiforme/generalized pustular figurate erythema/Stevens-Johnson syndrome (n = 22), ocular/periocular (n = 14), polymorphic pattern (n = 9), generalized pruritus (n = 8), Kawasaki disease (n = 5), atypical erythema nodosum (n = 3), and atypical Sweet syndrome (n = 1). Chilblain-like lesions were more frequent in the younger population and were linked to a milder disease course, while fixed livedo racemosa and retiform purpura appeared in older patients and seemed to predict a more severe prognosis. For vesicular rashes, PCR determined the presence of herpesviruses in the vesicle fluid, which raised the possibility of herpesvirus co-infections. The erythema-multiforme-like pattern, generalized pustular figurate erythema and Stevens-Johnson syndrome were most frequently linked to hydroxychloroquine intake. A positive PCR determination of SARS-COV-2 from conjunctival swabs suggest that eye discharge can also be contagious. These cutaneous manifestations may aid in identifying otherwise asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others.

Acute maculopapular eruption in Covid-19 patient: A case report.

We report the case of a positive COVID-19 patient who presented to our hospital for a maculopapular skin rash which appeared 7 days after the onset of COVID-19 symptoms. He was 34 years old and nothing relevant was recorded at his previous anamnesis. The patient was hospitalized for 3 days and received systemic therapy with steroid, antihistamines, tocilizumab, and hydroxicloroquine. On the third day of the hospitalization the cutaneous rash had almost completely disappeared.

Herpes zoster might be an indicator for latent COVID 19 infection.

Various cutaneous manifestations have been observed in patients with COVID-19 infection. Herpes zoster is a viral skin disease caused by varicella zoster that remains dormant in the dorsal root ganglia of cutaneous nerves following a primary chicken pox infection. In this report, we describe two cases COVID infection who first presented with herpes zoster. We are here by suggesting that the clinical presentation of HZ at the time of the current pandemic even in patients giving mild or no suggestive history of upper respiratory symptoms should be considered as an alarming sign for a recent subclinical SARS CoV2 infection.