Prospective Study of Sars-cov2 Associated Coagulopathy and Role of Complement Activation (preprint)

Sars-CoV2 associated coagulopathy is a complex entity. Platelets, coagulation factors, fibrinolysis, inflammatory cytokines, immunothrombosis, antiphospholipd antibodies, von Willebrand factor/ADAMTS13 axis, complement system have all been demonstrated to be actively involved in the determination of thrombotic events. Til now retrospective studies have analyzed the activaction of vWF/ADAMTS13 axis and complement involvement. We performed a prospective study with the aim of describing clinical and laboratoristic features of Sars-CoV2 associated coagulopathy and its relationship with complement activation. Biochemical variables, vWF/ADAMTS13 axis, complement factors of the enrolled patients have been analyzed. These variables have been correlated to clinical outcome of the disease. Covid associated coagulopathy is neither a Trombotic Trombocitopenc Purpura (TTP) nor and atypical hemolytic uremic syndrome (aSEU). Nevertheless, imbalance of vWF/Adamts13 axis and complement activation simultaneously occurre and are significantly higher in the severe form of disease.

Safety of BNT162b2 mRNA COVID-19 Vaccine in children with chronic kidney disease: a national population study of South Korea (preprint)

Background In South Korea, COVID-19 vaccination has been recommended to children since October 2021, targeting all teenagers aged 12–15 years, with emphasis on high-risk group including chronic kidney disease (CKD) pediatric patients. In this study, we aimed to assess the rate of adverse events following COVID-19 vaccination in children with CKD in South Korea, using national cohort data.Methods We retrieved the Korea Disease Control and Prevention Agency-COVID19-National Health Insurance Service (K-COV-N) cohort data linked to the National Health Insurance System (NHIS) data, to calculate rate of purpura and other hemorrhagic conditions, Guillain-Barré syndrome (GBS), myocarditis and/or pericarditis, and anaphylaxis incidence in children with CKD, after BNT162b2 vaccination.Results Among the 2,078 children with CKD, 69.2% (n = 1,437) had received BNT-162b2 vaccine. Guillain-Barré syndrome and anaphylaxis or anaphylactic shock did not occur during observed period. Purpura and hemorrhagic conditions were more frequent in the unvaccinated group (5/641 vs 1/1,437) while myocarditis/pericarditis was observed only in vaccinated group (0/641 vs 3/1437). The difference in the risk of any of these two events between vaccinated and unvaccinated groups was insignificant.Conclusions In this national cohort study of children with CKD in Korea, we found no evidence of increased risk of adverse events following BNT162b2 vaccination. Our results provide the safety profiles of COVID-19 vaccine for patients with CKD.

Cutaneous manifestations of Coronavirus Disease 2019.

BACKGROUND: COVID-19 has been linked to a variety of dermatological conditions. OBJECTIVE: To determine the presence of various cutaneous manifestations in patients with COVID-19, also to define their features in relation to the systemic symptoms. METHODS: This research enrolled a total of 1206 lab-confirmed COVID-19 individuals at a tertiary-care hospital in Karachi, Pakistan. Expert dermatologists assessed patients for COVID-related skin conditions. COVID-19 severity was categorized as asymptomatic/mild, moderate, or severe. RESULTS: Of the 102 (85.7%) patients with only one cutaneous sign, 26.5% developed maculopapular/morbiliform/erythematous rash; 14.7% urticaria; 9.85% vesicular/pustular exanthem; 14.7% vascular pattern; 12.7% infections, 7.8% miscellaneous and 9.8% late cutaneous findings A longer-lasting vascular pattern was related with an older age and a fatal COVID-19 outcomes (P: 0.000) compared with mild/moderate disease. Most of the retiform purpura presented exclusively with thromboembolic episodes. The moderate severity was correlated with maculopapular/morbiliform/exanthematous phenotype (P: 0.009), whereas urticaria was attributed to asymptomatic/mild disease (0.001) compared with moderate/severe infection. LIMITATIONS: Single-Center and observational study. CONCLUSION: Vascular lesions were correlated with disastrous COVID-19 outcomes, whereas retiform purpura was linked to adverse outcomes. The maculopapular/morbiliform/erythematous rash was associated with moderate severity, while the urticarial rash was linked to milder course compared with moderate/severe severity infection.

A Case of Leukocytoclastic Vasculitis Following SARS-COV-2 Vaccination.

BACKGROUND: Although vaccination against coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been proven generally safe, rare but potentially serious adverse reactions do occur. Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis that has been associated with other immunizations, but, to our knowledge, has not been previously reported in association with vaccines directed against SARS-CoV-2. CASE REPORT: We report the case of a 22-year-old man with no known past medical history who presented to the Emergency Department with 2 days of migratory arthritis in his ankles and palpable purpura on his bilateral lower extremities, occurring 10 days after receiving the Johnson & Johnson SARS-CoV-2 vaccine. The patient's clinical presentation was suggestive of leukocytoclastic vasculitis, and this diagnosis was confirmed on skin biopsy. Why Should an Emergency Physician Be Aware of This? Recognition of vasculitides is important for timely treatment and prevention of complications. In a patient presenting with palpable purpura after immunization against SARS-CoV-2, LCV should be promptly considered and worked up by the Emergency Physician, though management is most often entirely outpatient and the clinical course is typically mild and self-resolving.

Papulo-purpuric dermatitis of childhood: a distinct PLEVA-like eruption associated to SARS-CoV-2 infection. Clinical, histopathological and immunohistochemical study of 10 cases.

We observed ten children with a papular eruption with purpuric features during the SARS-CoV-2 pandemic in Northern Italy (May-December 2020). Histological examination showed signs of SARS-CoV-2-related dermatosis. Evidence of nucleocapsid viral proteins using SARS-CoV-2 (2019-nCoV) nucleocapsid antibody revealed cuticular staining of the deep portion of the eccrine glands in all cases.

A clinicopathological description of COVID-19-induced chilblains (COVID-toes) correlated with a published literature review.

BACKGROUND: The abundance of publications of COVID-19-induced chilblains has resulted in a confusing situation. METHODS: This is a prospective single-institution study from 15 March to 13 May 2020. Thirty-two patients received PCR nasopharyngeal swabs. Of these, 28 patients had a thoracic CT-scan, 31 patients had blood and urine examinations, 24 patients had skin biopsies including immunohistochemical and direct immunofluorescence studies, and four patients had electron microscopy. RESULTS: COVID-19-induced chilblains are clinically and histopathologically identical to chilblains from other causes. Although intravascular thrombi are sometimes observed, no patient had a systemic coagulopathy or severe clinical course. The exhaustive clinical, radiological, and laboratory work-up in this study ruled-out other primary and secondary causes. Electron microscopy revealed rare, probable viral particles whose core and spikes measured from 120 to 133 nm within endothelium and eccrine glands in two cases. CONCLUSION: This study provides further clinicopathologic evidence of COVID-19-related chilblains. Negative PCR and antibody tests do not rule-out infection. Chilblains represent a good prognosis, occurring later in the disease course. No systemic coagulopathy was identified in any patient. Patients presenting with acral lesions should be isolated, and chilblains should be distinguished from thrombotic lesions (livedo racemosa, retiform purpura, or ischemic acral necrosis).