ABSTRACT
Background: A variety of skin conditions are reported in association with COVID-19. Among these clinical patterns, urticarial lesions are described. We present a case of new-onset urticaria in an adult patient with mild COVID-19. In addition, we performed a comprehensive structured literature search to evaluate the temporal relationship between COVID-19 and urticarial manifestations and their duration. Method(s): This case report presents an adult patient with new-onset urticaria and confirmed diagnosis of COVID-19, assessed according to international guidelines. A systematic review was conducted for relevant studies published in Pubmed/Medline database, between January 2020 and January 2022, using specific keywords for clinical and temporal features of skin lesions. Result(s): A 28-year- old male with a 24-hour history of fever and headache presented new-onset urticarial lesions. In the context of COVID-19 pandemic, infection with SARS-CoV- 2 was suspected, and a PCR test detected viral RNA in a nasopharynx sample confirming the diagnosis in this patient. Other clinical manifestations and abnormal laboratory findings were not detected. A diagnosis of SARS-CoV- 2 infection-associated urticaria was established. The urticarial rash improved with oral new-generation H1 antihistamines and was remitted in 5 days. The outpatient treatment did not include systemic corticosteroid and antiviral therapy. Out of 3542 articles published in PubMed on cutaneous manifestations linked to COVID-19/ SARS-CoV- 2 infection, 53 met the criteria of assessing urticaria in these conditions. From these, 30 were case reports, 13 were case series and 10 were cohort studies. From 273 patients reported with urticaria, only 53 had a clear mention of a positive antigen or nucleic acid amplification viral test. Urticaria preceded the onset of respiratory/systemic COVID-19 symptoms in 12 patients, appeared at the same time in 81 patients, and as a late manifestation in 45 patients. For 135 patients, the timing was not specified. Urticarial lesions were remitted between several hours to 12 weeks, either spontaneously or with symptomatic treatment. Conclusion(s): Based on reported cases, urticaria may be associated with COVID-19. There is a need for more relevant studies regarding urticaria in these infectious conditions, with detailed data on clinical pattern, time of onset, duration, severity, need for specific treatment and prognosis.
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Background: Until January 2022, 8.975.458 cases of COVID-19 have been reported in Spain. In December of 2020, the European Union authorized the first mRNA vaccines against SARS-COV- 2, developed by Pfizer-BioNTech and Moderna, with two doses separated by 21 and 28 days, respectively. Reports of severe allergic reactions, including anaphylaxis, have prompted concern that the new mRNA vaccine platform has the potential to cause allergic reactions (including anaphylaxis) at a greater rate than other vaccines. Method(s): Immunization process started at Hospital Ramon y Cajal (Madrid, Spain) in January 2021. The hospital provided a form to report any adverse effect after the first or second dose of the vaccine. Until today, in our Allergy Department, we have received more than 500 patients with suspected adverse reaction to the vaccine, although the data in this publication are collected from January 2021 to September 2021. All of them were referred from different services (Occupational Risk Prevention Department, Preventive Medicine Department, General Practitioners and other specialties) by telephone, e-mail or personally at our service. Result(s): Out of the 139 vaccinated patients who reported adverse effects, 131 had a reaction with the first dose, of whom 65% were women. 51% were local reactions and 49% systemic, of which 62% were immediate reactions. We performed diagnostic tests in 55% of the patients: prick test (with macrogol, triamcinolone, dexketoprofen, methylprednisolone acetate, PEG), ID test (with triamcinolone, dexketoprofen, methylprednisolone acetate) with immediate reading and delayed reading in case of delayed reactions, epicutaneous tests (with PEG and polysorbate 80) and blood tests in systemic reactions. All diagnostic tests showed negative results. 82% of patients that reported adverse effects after the first dose tolerated the second dose of the vaccine without incidents. Only one patient had a reaction to the first and second dose despite a negative study, a 58-year- old woman who presented an urticarial rash 24 hours after administration. 8 patients, all of them women, were referred for reaction after the second dose, 87% of whom had tolerated the first dose. Conclusion(s): This single-center experience suggests that most patients who had mild reactions to the first dose of mRNA vaccines have received the second dose uneventfully or with only mild repeat reactions.
ABSTRACT
BACKGROUND: Although the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily responsible for respiratory symptoms, an increasing number of cutaneous manifestations have been reported. Cutaneous manifestations are reported by patients following disease recovery. OBJECTIVE: We sought to document various skin lesions relating to COVID-19 symptoms either before, during, or after infection with severe acute respiratory syndrome coronavirus 2. METHODS: This was a descriptive study with 273 patients who had cutaneous manifestations after recovering from COVID-19. Each patient provided a thorough medical history and underwent a general physical examination. Following polymerase chain reaction analysis, all participants were confirmed to be COVID-19 patients. RESULTS: Acral lesions were the most common, accounting for 39% of all cases. An erythematous maculopapular rash was found in 21% of cases and was the second most common after urticaria, with fewer cases of erythema multiform, vesicular rash (9%), vascular livedo reticularis, figurate erythema, and flexural rash documented. CONCLUSION: The most common cutaneous changes seen in patients with COVID-19 were pseudo-chilblain acral lesions, which had a good prognosis. Vascular rashes within the spectrum of livedo/purpura/necrosis were seen with severe forms of COVID-19.
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Background/Aims There is a growing number of reports of new-onset autoimmune disease or complications of underlying autoimmune disorders following COVID-19 infection and vaccination. Methods We describe two cases of systemic lupus erythematosus (SLE) that developed De novo in two female patients shortly after receiving their COVID-19 vaccinations. Results The first case is a 29-year-old female with no prior medical history. One week following her COVID-19 Pfizer/BioNTech vaccination, she developed widespread pruritus, fatigue, myalgia, arthralgia, fever and night sweats. Blood tests showed pancytopenia and she was referred for an urgent haematology opinion due to lymphoma. Positron Emission Tomography/computed tomography (PET/CT) demonstrated widespread lymphadenopathy. Bone and lymph node biopsy showed reactive changes only. Her symptoms progressed with polyarticular inflammatory arthritis, oral ulceration, Raynaud's, pleuritic chest pain, palmar purpuric rash, and a widespread tender urticarial rash. Further investigations showed low complement C3/C4, anti-double stranded DNA antibody titre (dsDNA) >200 IU/mL, positive Anti-Ro antibody, positive Anti-La antibody, weakly positive anti-RNP antibody and an Anti-C1q antibody >400 units/ml with a urine protein/creatinine ratio (PCR) of 39 mg/mmol. A diagnosis of SLE with urticarial vasculitis was made and she commenced Hydroxychloroquine in addition to weaning prednisolone (60mg). A skin biopsy confirmed lupus vasculitis. Despite high dose prednisolone, urine PCR increased over 2 weeks from 39 to 84 mg/mmol. Renal biopsy demonstrated class 3 lupus nephritis. She was pulsed with 500mg IV methyl prednisolone over 3 days and commenced mycophenolate 1g BD. Within weeks she was in clinical remission. The second case is a 70-year-old female with a past medical history of diverticulosis, uterine fibroids and small hand joint osteoarthritis. She presented with a sudden onset, 6-week history of bilateral symmetrical small and large joint synovitis that developed 8 days following the first dose of the COVID-19 Oxford-AstraZeneca vaccine. Her investigations showed reduced lymphocyte counts (0.9 109/L), raised CRP 26 mg/L and ESR 32 mm/hr. Antinuclear antibodies were weakly positive with a homogenous pattern. DsDNA titre was raised at 175 IU/mL and C4 reduced at 0.14 g/L. There was no proteinuria or any evidence of major internal organ involvement. She was started on a short reducing course of oral prednisolone given the severity of her presenting clinical features. Her symptoms improved, with no recurrence on stopping steroids but she has continued elevation in DsDNA;a conservative management approach is being adopted. Conclusion Both cases met the EULAR/ACR and SLICC classification criteria for SLE. There was a clear temporal association between the onset of SLE symptoms and COVID-19 vaccination. Our cases raise the possible association/causation of SLE following COVID-19 vaccination. Potential mechanisms include immune responses elicited by the COVID-19 vaccination, triggering autoimmunity in genetically predisposed individuals. Further research and data from registries are required.
ABSTRACT
The emergence of the novel SARS-CoV-2 coronavirus and rapid spread of the COVID-19 disease it causes in late 2019 and early 2020 has since led to a global pandemic announced by the World Health Organization (WHO). The pandemic is a steadily growing social, economic, psychological, and health burden. The infection rates worldwide are climbing. COVID-19 is considered a systemic disease, potentially resulting in acute respiratory distress and cardiovascular failure leading to death. Yet, SARS-CoV-2, a novel and still under-studied virus, has been documented to cause a large variety of symptoms, in many cases including cutaneous manifestations. This paper is a review of medical literature available to date regarding the cutaneous manifestations in the course of SARS-CoV-2 infection. It is also aimed at discussing the significance of dermatological findings for improved diagnosis and treatment of COVID-19 patients. Considering the gravity of the novel coronavirus pandemic, an improved dermatological approach would aid timely diagnosis and effective management of COVID-19, and would facilitate classification of the cutaneous abnormalities observed.
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The ongoing COVID-19 pandemic, declared by the World Health Organisation in March 2020, with the emergence of new, possibly more contagious and more virulent strains, remains a research subject, with the complex systemic involvement better described and understood, but also with a variety of skin and mucosal lesions described in the literature. Mucocutaneous lesions associated with SARS-CoV-2 infection are still under investigation, due to their polymorphic clinical aspect and incompletely understood pathogenic mechanism. The cutaneous inflammatory, exanthematous and purpuric rashes, erythemato-purpuric enanthems, oral ulcers, lichenoid oral lesions, conjunctivitis, conjunctival pseudomembranes, or corneal lesions have been described in patients with COVID-19. Several classifications have been proposed based on the clinical pattern, histological findings, and possible pathogenic mechanisms. The pathogenic mechanism, the diagnostic criteria, the prognostic importance of these lesions are still being debated. The diverse clinical aspects of dermatological manifestations render the diagnosis difficult. However, several clinical patterns strongly associated with COVID-19, such as chilblains, papulovesicular exanthems, and febrile rash require increased awareness and changes to the investigation protocols for these conditions, to include testing for SARS-CoV-2. In the present review, the mucocutaneous findings associated with the novel coronavirus infection, reported thus far in the literature, was provided.