Subject(s)
Betacoronavirus/pathogenicity , Chilblains/pathology , Chilblains/virology , Coronavirus Infections/pathology , Coronavirus Infections/virology , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , Administration, Topical , Adolescent , Adrenal Cortex Hormones , COVID-19 , Coronavirus Infections/immunology , Enzyme-Linked Immunosorbent Assay , Female , Fingers/blood supply , Fingers/virology , Humans , Pandemics , Patient Education as Topic , Pneumonia, Viral/immunology , Quarantine , SARS-CoV-2 , Toes/blood supply , Toes/virologyABSTRACT
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).
Subject(s)
COVID-19/complications , COVID-19/diagnosis , Chilblains/etiology , Chilblains/pathology , Toes/pathology , Adolescent , Adult , Aged , Biopsy/methods , COVID-19/metabolism , COVID-19/virology , Chilblains/diagnosis , Chilblains/virology , Child , Diagnosis, Differential , Eccrine Glands/pathology , Eccrine Glands/ultrastructure , Eccrine Glands/virology , Endothelium/pathology , Endothelium/ultrastructure , Endothelium/virology , Female , Humans , Livedo Reticularis/pathology , Male , Microscopy, Electron/methods , Middle Aged , Prognosis , Prospective Studies , Purpura/pathology , SARS-CoV-2/genetics , Skin/pathology , Toes/virology , Young AdultABSTRACT
Dermatological manifestations have shown to be associated with COVID-19 infections. The numbers of papers have quadrupled within May 2020 alone. One particular cutaneous manifestation named pseudo chilblains (COVID toe), expressed mostly in otherwise asymptomatic younger patients, has had particular media attention. Public health bodies, on the other hand, have been slow to recognize it as a symptom. This article will be discussing two case studies to demonstrate the lack of public knowledge and of public health guidance associated with this symptom. We will further explore the use of COVID toe in the epidemiology of COVID-19 and its utility as a sign for total cases and contact tracing.