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2.
Pediatrics ; 149(1)2022 01 01.
Article in English | MEDLINE | ID: covidwho-1595609

ABSTRACT

A 9-year-old girl presented to her primary care pediatrician via telemedicine during the initial months of the coronavirus disease 2019 pandemic because of 4 days of warmth perceived by her mother, decreased energy, and a new rash on her upper extremities. After 10 additional days of documented fever >38°C, worsening fatigue, and 1 day of nausea, vomiting, and diarrhea, she was allowed to schedule an in-person visit with her pediatrician after testing negative for severe acute respiratory syndrome coronavirus 2. She appeared ill on arrival to clinic, and her pediatrician recommended evaluation in an emergency department. Her initial laboratory testing revealed nonspecific elevation in several inflammatory markers and leukopenia, and she responded well to intravenous hydration. Over the next 2 weeks, her fever persisted, constitutional symptoms worsened, and she developed progressively painful cervical lymphadenopathy and pancytopenia. She was evaluated in clinic by several specialists and eventually was urged to present to the emergency department again, at which time she was admitted to the PICU. After consulting additional specialists and waiting for laboratory results, the team reached a definitive diagnosis and initiated therapy; however, she experienced rapid clinical decline shortly thereafter. The specialists who assisted with identification of the underlying etiology of her symptoms were able to work together to manage the subsequent complications.


Subject(s)
Exanthema , Fever , Intensive Care Units, Pediatric , Lupus Erythematosus, Systemic/diagnosis , Telemedicine , COVID-19/complications , COVID-19/diagnosis , Child , Disease Progression , Exanthema/diagnosis , Exanthema/etiology , Female , Fever/etiology , Histiocytic Necrotizing Lymphadenitis/diagnosis , Humans , Lupus Erythematosus, Systemic/blood , Lupus Erythematosus, Systemic/complications , Lymphadenopathy/diagnosis , Lymphadenopathy/etiology , Pancytopenia/diagnosis , Symptom Assessment , Systemic Inflammatory Response Syndrome/diagnosis
3.
Eur J Clin Microbiol Infect Dis ; 40(10): 2243-2248, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1491170

ABSTRACT

In a large regional observational cohort study of adult (≥ 18 years), outpatients with COVID-19, prevalence, characteristics, and outcome of patients with rash and/or chilblain-like lesions (CLL), compared with population without cutaneous features, were studied. In total, 28,957 outpatients were included; the prevalence of rash and CCL were 9.5% and 3.7%, respectively. Presence of rash was significantly associated with presence of asthenia, shivers or myalgia, respiratory and gastro-intestinal symptoms, and anosmia/ageusia. The presence of CCL was associated with chest pain, chest oppression, nausea/vomiting, and anosmia/ageusia. Patients with CCL were significantly less prone to an unfavourable outcome (hospitalization or death).


Subject(s)
COVID-19/complications , Chilblains/etiology , Exanthema/etiology , Adult , Aged , Chilblains/diagnosis , Cohort Studies , Exanthema/diagnosis , Female , Humans , Male , Middle Aged , Outpatients , Prognosis , SARS-CoV-2/genetics , SARS-CoV-2/physiology
6.
Adv Exp Med Biol ; 1327: 119-127, 2021.
Article in English | MEDLINE | ID: covidwho-1316242

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a multiple organ disease caused by SARS-CoV-2 virus infection. Among the organs and tissues affected by the disease, the skin has received less attention. Skin is the largest tissue in the body and is responsible for temperature maintenance, protection against external dangers and dehydration, and other roles. Although the skin manifestations of COVID-19 are common, the lack of standardization in the description of its signs makes it difficult to group them together. Considering the literature available so far, the skin manifestations can be divided into 4 patterns: exanthem, urticarial lesions, vascular and acro-papular eruptions. The localization, age, onset, symptoms and severity vary among them. The treatment, when necessary, is usually focused on the inflammatory response control. The pathophysiological mechanisms seem to involve the apoptosis of keratinocytes as well as endothelial cell dysfunction, favouring the establishment of skin inflammation. The better characterization of the skin manifestations is essential to understand the possible effects of COVID-19 on skin as well as for the development of appropriate treatments.


Subject(s)
COVID-19 , Exanthema , Early Diagnosis , Exanthema/diagnosis , Humans , Prognosis , SARS-CoV-2
7.
Eur J Clin Microbiol Infect Dis ; 40(10): 2243-2248, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1306704

ABSTRACT

In a large regional observational cohort study of adult (≥ 18 years), outpatients with COVID-19, prevalence, characteristics, and outcome of patients with rash and/or chilblain-like lesions (CLL), compared with population without cutaneous features, were studied. In total, 28,957 outpatients were included; the prevalence of rash and CCL were 9.5% and 3.7%, respectively. Presence of rash was significantly associated with presence of asthenia, shivers or myalgia, respiratory and gastro-intestinal symptoms, and anosmia/ageusia. The presence of CCL was associated with chest pain, chest oppression, nausea/vomiting, and anosmia/ageusia. Patients with CCL were significantly less prone to an unfavourable outcome (hospitalization or death).


Subject(s)
COVID-19/complications , Chilblains/etiology , Exanthema/etiology , Adult , Aged , Chilblains/diagnosis , Cohort Studies , Exanthema/diagnosis , Female , Humans , Male , Middle Aged , Outpatients , Prognosis , SARS-CoV-2/genetics , SARS-CoV-2/physiology
10.
JNMA J Nepal Med Assoc ; 59(236): 399-401, 2021 Apr 30.
Article in English | MEDLINE | ID: covidwho-1257582

ABSTRACT

As the current COVID-19 pandemic is evolving, skin lesions are being reported more, the most common skin manifestation being morbilliform rashes. We describe a patient of severe COVID-19 infection, 48-year-old who initially presented with fever, cough and constitutional symptoms who developed morbilliform macular rashes during his illness. The rash appeared on 6th day of illness in the trunk, arms with sparing of palms and soles, associated with itching. He later developed features of the cytokine-storm syndrome. The exact mechanism for the rashes is yet to be elaborated, however, it is postulated that it is either due to immune-mediated vasodilation or micro thrombosis secondary to low-grade-coagulopathy associated with COVID-19. Recognition of rashes as a feature of this disease is particularly significant to clinicians as it aids in early diagnosis, particularly in resource-poor countries. There is no evident association, however, between the severity and the rashes in COVID-19 infection.


Subject(s)
COVID-19 , Exanthema , Exanthema/diagnosis , Exanthema/etiology , Humans , Male , Middle Aged , Pandemics , Pruritus , SARS-CoV-2
11.
Dermatol Clin ; 39(4): 521-532, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1252652

ABSTRACT

Cutaneous findings have increasingly been reported in patients with coronavirus disease 2019 (COVID-19). This review discusses associated skin findings in patients with COVID-19 in the inpatient setting, ranging from vasculopathy-related lesions associated with high hospitalization rate and poor prognosis to inflammatory vesicular and urticarial eruptions that are rarely associated with prolonged hospitalization. We also discuss other reported COVID-19 cutaneous manifestations such as Sweet's syndrome, purpuric eruptions, and Multisystem Inflammatory Syndrome in Children. Although the relationship between dermatologic changes and COVID-19 disease progression is not fully elucidated, familiarity with cutaneous manifestations is valuable for physicians caring for patients hospitalized with COVID-19 and may help improve disease recognition and care.


Subject(s)
COVID-19/complications , COVID-19/diagnosis , Inpatients/statistics & numerical data , Skin Diseases/diagnosis , Skin Diseases/etiology , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/diagnosis , Adult , COVID-19/pathology , Chilblains/diagnosis , Chilblains/etiology , Child , Exanthema/diagnosis , Exanthema/etiology , Humans , Pityriasis Rosea/diagnosis , Pityriasis Rosea/etiology , Skin Diseases, Vascular/diagnosis , Skin Diseases, Vascular/etiology , Systemic Inflammatory Response Syndrome/pathology , Urticaria/diagnosis , Urticaria/etiology
12.
Cutis ; 107(4): 209-215, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1239179

ABSTRACT

Cutaneous manifestations of COVID-19-SARS-CoV-2-are common and varied. Morbilliform, vesicular, and urticarial eruptions may be nonspecific initial features of the disease. Chilblainlike lesions on the fingers or toes typically occur as part of a resolution phase, signifying a milder course, whereas livedoid lesions and retiform purpura are associated with coaguloapthy and more severe disease. Additionally, a severe Kawasaki-like multisystem inflammatory syndrome rarely is seen in children. This diverse range of cutaneous manifestations in COVID-19 reflects a spectrum of host immunologic responses to SARS-CoV-2 and may inform disease pathophysiology.


Subject(s)
COVID-19/complications , Severity of Illness Index , Skin Diseases/diagnosis , Skin Diseases/etiology , COVID-19/epidemiology , COVID-19 Testing , Dermatology , Exanthema/diagnosis , Exanthema/etiology , Female , Humans , Male , Purpura/diagnosis , Purpura/etiology , Skin/pathology , Skin Diseases/virology , Skin Diseases, Viral/diagnosis , Skin Diseases, Viral/etiology , Urticaria/diagnosis , Urticaria/etiology
13.
Rheumatol Int ; 41(6): 1021-1036, 2021 06.
Article in English | MEDLINE | ID: covidwho-1152001

ABSTRACT

Anti-Melanoma Differentiation-Associated gene 5 (MDA-5) Dermatomyositis (MDA5, DM) is a recently identified subtype of myositis characteristically associated with Rapidly Progressive Interstitial Lung Disease (RP-ILD) and unique cutaneous features. We reviewed PubMed, SCOPUS and Web of Science databases and selected 87 relevant articles after screening 1485 search results, aiming to gain a better understanding of the pathophysiology, clinical features, diagnosis, and treatment approaches of anti-MDA-5 DM described in the literature. The etiopathogenesis is speculatively linked to an unidentified viral trigger on the background of genetic predisposition culminating in an acquired type I interferonopathy. The clinical phenotype is highly varied in different ethnicities, with new clinical features having been recently described, expanding the spectrum of cases that should raise the suspicion of anti-MDA-5 DM. Unfortunately, the diagnosis is frequently missed despite excessive mortality, calling for wider awareness of suspect symptoms. RP ILD is the major determinant of survival, treatment being largely based on observational studies with recent insights into aggressive combined immunosuppression at the outset.


Subject(s)
Dermatomyositis/diagnosis , Dermatomyositis/therapy , COVID-19/diagnosis , Dermatomyositis/epidemiology , Dermatomyositis/virology , Disease Progression , Exanthema/diagnosis , Exanthema/etiology , Exanthema/virology , Female , Humans , Interferon-Induced Helicase, IFIH1 , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/etiology , Lung Diseases, Interstitial/virology , Male , Prevalence , SARS-CoV-2
15.
Pediatr Dermatol ; 38(3): 629-631, 2021 May.
Article in English | MEDLINE | ID: covidwho-1105364

ABSTRACT

Since the onset of the COVID-19 pandemic, the growing body of literature has largely focused on the adult population. Reported symptoms among children appear to be consistent with those in adults, including fever, respiratory symptoms, and gastrointestinal symptoms, though children may experience an overall milder disease course. Viral exanthems with possible association to COVID-19 have been reported in pediatric patients. We describe a 10-month-old boy with Gianotti-Crosti syndrome in the setting of recent SARS-CoV-2 RT-PCR positive testing to increase physician awareness and add to the collection of cutaneous manifestations of COVID-19.


Subject(s)
Acrodermatitis , COVID-19 , Exanthema , Acrodermatitis/diagnosis , Acrodermatitis/etiology , Child , Exanthema/diagnosis , Exanthema/etiology , Humans , Infant , Male , Pandemics , SARS-CoV-2
16.
J Dermatol ; 48(5): 651-656, 2021 May.
Article in English | MEDLINE | ID: covidwho-1096631

ABSTRACT

It is not yet entirely clear what is the relevance of skin symptoms and what clinical implications are related to their appearance in COVID-19 patients. We describe two cases of COVID-19-associated pneumonia, which presented skin manifestations in advanced stage of illness, when nasopharyngeal swabs became negative for SARS-CoV-2. The first case presented erythematous, maculopapular lesions; the second developed petechial, vesicular and blood-encrusted lesions on the limbs. Histopathology documented perivascular lymphocytic infiltrates, with prevalent CD4+ T-cells in both patients. The research of SARS-CoV-2 in tissues with real time RT-PCR was negative. Basal keratinocytes displayed C4d deposits in one case, who developed laboratory signs indicative of a procoagulative condition at the same time as the skin rash. Skin manifestations during SARS-CoV-2 infection seem to be clinically relevant and further studies are necessary to assess if they are linked to systemic complications, lack of viral clearance or cascades of immune responses induced by the virus, even in patients affected by mild pneumonia.


Subject(s)
COVID-19 , Exanthema , COVID-19 Testing , Erythema , Exanthema/diagnosis , Exanthema/etiology , Humans , SARS-CoV-2
17.
Adv Emerg Nurs J ; 43(1): 28-34, 2021.
Article in English | MEDLINE | ID: covidwho-1087872

ABSTRACT

The CoVID-19 pandemic has impacted all areas of health care, especially emergency medicine. Most commonly, CoVID-19 is associated with respiratory and typical viral presentations. However, nonrespiratory presentations are becoming more common. Reported CoVID-19 dermatological changes include maculopapular and urticarial rashes, chilblain-like and livedo reticularis discolorations, and less commonly vesicular and petechial rashes. As frontline clinicians, emergency nurse practitioners should be aware of these skin findings to recognize potentially infected and otherwise asymptomatic patients. Early recognition could potentially lead to an earlier diagnosis and limit the spread of severe acute respiratory syndrome coronavirus 2.


Subject(s)
COVID-19/complications , Exanthema/diagnosis , COVID-19/virology , Diagnosis, Differential , Exanthema/drug therapy , Exanthema/etiology , Humans , Male , Middle Aged , SARS-CoV-2
19.
Emerg Infect Dis ; 27(4): 1196-1200, 2021 04.
Article in English | MEDLINE | ID: covidwho-1067635
20.
Dermatol Ther ; 34(2): e14788, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1044098

ABSTRACT

In this systematic review, we anticipated in summarizing clinical features, histopathological hallmarks, and possible pathology behind the maculopapular skin eruptions occurring in Covid-19 patients. A literature search was executed using MEDLINE/PubMed and Embase databases for articles published till 20 November 2020. All eligible articles including observational studies, case reports, and case series reporting the maculopapular skin lesion in Covid-19 patients were included. Data were obtained for 354 Covid-19 patients presenting with maculopapular lesions from 40 studies. The mean age of these patients was 53 years, and with 42% of them being male. These maculopapular lesions differed considerably in terms of distribution and appearance, ranging from diffuse erythematous maculopapular lesions to scattered erythematous macules coalescing into papules to maculopapular lesions in plaques. The mean duration of the lesion was 8 days. These lesions were frequently localized on trunks and extremities. Superficial perivascular dermatitis with lymphocytic infiltrate was a histopathological hallmark of these lesions. As these skin lesions may have a possible association with diagnosis, management, prognosis, and severity of the disease, all health practitioners need to be well acquainted with these Covid-19 skin lesions. Also, in the middle of this worldwide pandemic, early identification of this eruption may help manage this infection's further spread.


Subject(s)
COVID-19 , Drug Eruptions , Exanthema , Drug Eruptions/diagnosis , Drug Eruptions/etiology , Exanthema/diagnosis , Exanthema/etiology , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
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