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J Dermatol ; 48(10): 1588-1592, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1319212


In the worldwide coronavirus disease 2019 (COVID-19) outbreak, skin manifestations were seen in COVID-19 patients. We report a case in which a COVID-19 patient developed cutaneous lesions that were diagnosed as erythema nodosum-like lesions, which were associated with COVID-19. Nasopharyngeal swab polymerase chain reaction (PCR) confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Histopathologically, extensive inflammation was seen from the epidermis to the fat tissue. An organized thrombus and disrupted inner elastic lamina were seen in an intradermal vessel. These findings suggest septal panniculitis with cutaneous polyarteritis nodosa. The results of PCR using the specimen of skin lesion was negative. The patient took non-steroidal anti-inflammatory drugs and the skin lesion improved in 3 weeks. To characterize the skin eruption, we reviewed previous reports on COVID-19 (confirmed by the detection of SARS-CoV-2 infection) from Asian countries. The type of eruption and timing of its appearance in this case seemed rare. Differences in skin manifestations between Western and Asian countries were noted.

COVID-19 , Erythema Nodosum , Exanthema , Asia , Erythema Nodosum/diagnosis , Erythema Nodosum/drug therapy , Humans , SARS-CoV-2
Int J Infect Dis ; 103: 549-551, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-974113


Type 2 leprosy reaction (T2LR), or Erythema Nodosum Leprosum (ENL), often poses a therapeutic challenge to clinicians and commonly requires long courses of steroids for control. While immunosuppressants are known to achieve control and lower steroid dependence in T2LR, the prospect of managing a severe T2LR in conjunction with COVID-19, with the concern of worsening COVID-19 with long-term immunosuppression has not previously been encountered. We report a case of severe T2LR treated with oral steroids and methotrexate, with COVID-19 infection acquired during hospital stay, and a favourable outcome achieved despite the continued use of immunosuppressants. We discuss the possible reasons for this both in terms of the drug pharmacodynamics and the immunological profile of T2LR.

Adrenal Cortex Hormones/administration & dosage , COVID-19/drug therapy , Erythema Nodosum/drug therapy , Immunosuppressive Agents/therapeutic use , Leprosy, Lepromatous/drug therapy , Methotrexate/administration & dosage , SARS-CoV-2 , Adult , COVID-19/immunology , Erythema Nodosum/immunology , Humans , Leprosy, Lepromatous/immunology , Male