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1.
Nature ; 603(7903): 779, 2022 03.
Article in English | MEDLINE | ID: covidwho-1747258

Subject(s)
COVID-19 , Humans , Toes
4.
Cutis ; 108(5): 276-295, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1534583

ABSTRACT

So-called COVID toes is probably the most publicized cutaneous manifestation of COVID-19. The parents of 4 patients pursued dermatology evaluation with concerns about COVID-19 infection in their children who presented with symmetric, focal, erythematous lesions of the hands or feet, or both. We elicited a history of extended time in swimming pools for the 4 patients that was associated with COVID-19 restrictions during summer months of the pandemic and recognized findings of frictional and pressure-induced erythema and scaling, leading to a diagnosis of pool palms and feet-an extension of pool palms. It is important to recognize this diagnosis and provide reassurance to the patients and caregivers because the condition warrants no notable workup or therapeutic intervention.


Subject(s)
COVID-19 , Child , Foot , Hand , Humans , SARS-CoV-2 , Toes
5.
Clin Dermatol ; 39(3): 380-383, 2021.
Article in English | MEDLINE | ID: covidwho-1491858

ABSTRACT

More than 40 million people have been infected with the severe acute respiratory syndrome coronavirus 2 since the first infection was reported in December 2019 from Wuhan, China. Multiple reports of cutaneous manifestations of the virus have been described, including a pernio-like eruption, recently termed "COVID toes." We have reviewed the published case series on "COVID toes" in addition to studies identifying possible pathogenic mechanisms behind the eruption.


Subject(s)
COVID-19 , Chilblains , Exanthema , Chilblains/diagnosis , Chilblains/epidemiology , Humans , SARS-CoV-2 , Toes
6.
Vasc Endovascular Surg ; 56(2): 201-207, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1443761

ABSTRACT

We present a 74-year-old gentleman, who presented with foot ischaemia requiring bilateral amputation in the absence of radiological signs of occlusive peripheral arterial disease. He was found to have COVID-19 pneumonitis and concurrent arterial and venous thromboemboli despite no initial respiratory symptoms or signs, nor pre-existing risk factors for cardiovascular disease. Patients who present with foot ischaemia with or without respiratory symptoms or signs warrant a high index of suspicion for COVID-19 infection, particularly in those with no predisposing risk factors.


Subject(s)
COVID-19 , Peripheral Arterial Disease , Venous Thromboembolism , Aged , Humans , Ischemia/diagnostic imaging , Ischemia/etiology , Lower Extremity , Male , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/diagnostic imaging , SARS-CoV-2 , Toes , Treatment Outcome
7.
Pediatr Dermatol ; 38(5): 1143-1149, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1405195

ABSTRACT

BACKGROUND: Coronavirus disease (COVID-19) is related to several extrapulmonary disorders; however, little is known about the clinical, laboratory, and histopathological characteristics of pernio-like skin lesions associated with COVID-19 infection. OBJECTIVE: To evaluate and summarize the clinical, laboratory, and histopathological characteristics of pernio-like lesions reported in the literature. METHODS: We conducted a search of the PubMed, SciELO, and ScienceDirect databases for articles published between January 1, 2020 and November 30, 2020, following the PRISMA recommendations (PROSPERO registration ID: CRD42020225055). The target population was individuals with suspected or laboratory-confirmed COVID-19 with pernio-like lesions. Observational studies, research letters, and case/series reports were all eligible for inclusion. Observational studies were evaluated using a random-effects model to calculate the weighted mean prevalence, overall mean, and 95% confidence interval. We evaluated case studies using the chi-square test for dichotomous variables and the Mann-Whitney test for continuous variables. RESULTS: A total of 187 patients from case reports and 715 patients from 18 observational studies were included. The mean age of patients was 16.6 years (range 14.5-18.8). Feet were affected in 91.4% (87.0-94.4%) of patients in observational studies. The proportion of patients with a positive RT-PCR test was less than 15%. Lesion topography and morphology were associated with age. CONCLUSION: Lesions mostly occurred in pediatric patients, and the morphological characteristics tended to differ between pediatric and non-pediatric populations. There is a possible multifactorial component in lesion pathophysiology. The non-positivity of laboratory tests does not exclude an association with COVID-19. Pernio-like lesions may be a late manifestation of COVID-19.


Subject(s)
COVID-19 , Chilblains , Adolescent , Child , Humans , Laboratories , Observational Studies as Topic , SARS-CoV-2 , Toes
9.
Am J Dermatopathol ; 43(8): 554-555, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1364851

ABSTRACT

ABSTRACT: "Severe acute respiratory syndrome coronavirus-2" (SARS-CoV-2) infection has variable described dermatologic manifestations. "COVID (coronavirus disease) toes" became a hallmark of the disease in young and largely asymptomatic patients, who may have negative test results for SARS-CoV-2. Pernio (chilblains)-like lesions are seen mostly in infected pediatric patients and are purple painful, frequently bilateral, ill-defined plaques with prominent inflammation on histological examination. In contrast to pernio-like presentation in children, critically ill adult patients with SARS-CoV-2 develop "purple" digits that may be sharply demarcated and may demonstrate asymmetric areas of ischemia. These 2 contrasting entities are sometimes grouped together as "COVID toes" due to some similarities in clinical appearance and presentation. Here, we summarize histopathologic examination from an autopsy, including the cutaneous lesions from the affected and normal contralateral toes and correlate them with systemic findings. In contrast to pernio-like lesions, the skin of the affected necrotic toes contained thrombi in vessels without prominent inflammation, suggestive of an embolic event. This is further supported by the clinical history of and autopsy findings of popliteal artery thrombus and multiple subsegmental pulmonary emboli. Our findings suggest that critically ill patients with SARS-CoV-2 have different pathological processes affecting skin at peripheral sites (ie, fingers, toes, ears, and nose), which may be due to thromboembolic events. The skin is a mirror of the body and skin pathology may shed light into overall pathogenesis of systemic illness and processes.


Subject(s)
COVID-19/complications , COVID-19/pathology , Thrombosis/virology , Toes/pathology , Autopsy , Humans , Male , Middle Aged , SARS-CoV-2 , Toes/blood supply
10.
J Cutan Pathol ; 49(1): 17-28, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1349942

ABSTRACT

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 Adult
11.
Ann Am Thorac Soc ; 18(7): 1116-1117, 2021 07.
Article in English | MEDLINE | ID: covidwho-1325447
12.
Clin Dermatol ; 39(1): 84-91, 2021.
Article in English | MEDLINE | ID: covidwho-1300694

ABSTRACT

The emergence of the coronavirus disease 2019 (COVID-19) worldwide pandemic has been associated with a new constellation of cutaneous features in children. Among the unusual dermatologic presentations are the so-called COVID toes, inflammatory nodules of the feet and toes, sometimes involving the hands and fingers. These lesions mimic acral pernio, the synonym being chilblains. Unlike adult patients with COVID toes, children are less likely to manifest symptomatic COVID-19. Although a few studies have found some linkage to COVID-19 through the serum IgA or IgG severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein, other studies have no demonstrable linkage suggesting that barefoot children in cold weather develop such lesions. It appears that the chilblain-like lesions related to the period of the COVID-19 pandemic may reflect a brisk immune response portending a good prognosis and perhaps some form of innate immunity. The possible need to screen for coagulopathy is unclear, but this has been suggested in one report. Until we fully understand the pattern of immune response to COVID-19, questions may persist as to how disease manifestations are linked to SARS-CoV-2 exposures.


Subject(s)
COVID-19/complications , Chilblains/virology , Foot Dermatoses/virology , Hand Dermatoses/virology , Adolescent , Chilblains/immunology , Child , Child, Preschool , Fingers , Foot Dermatoses/immunology , Hand Dermatoses/immunology , Humans , Infant , Infant, Newborn , SARS-CoV-2 , Toes
13.
Curr Probl Diagn Radiol ; 50(6): 842-855, 2021.
Article in English | MEDLINE | ID: covidwho-1294548

ABSTRACT

Coronavirus Disease 2019 (COVID-19) disease has rapidly spread around the world after initial identification in Wuhan, China, in December 2019. Most common presentation is mild or asymptomatic disease, followed by pneumonia, and rarely- multiorgan failure and Acute Respiratory Distress Syndrome (ARDS). Knowledge about the pathophysiology, imaging and treatment of this novel virus is rapidly evolving due to ongoing worldwide research. Most common imaging modalities utilized during this pandemic are chest radiography and HRCT with findings of bilateral peripheral, mid and lower zone GGO and/or consolidation, vascular enlargement and crazy paving. HRCT is also useful for prognostication and follow-up of severely ill COVID-19 patients. Portable radiography allows follow-up of ICU patients & obviates the need of shifting critically ill patients and disinfection of CT room. As the pandemic has progressed, numerous neurologic manifestations have been described in COVID-19 including stroke, white matter hyperintensities and demyelination on MRI. Varying abdominal presentations have been described, which on imaging either show evidence of COVID-19 pneumonia in lung bases or show abdominal findings including bowel thickening and vascular thrombosis. Numerous thrombo-embolic and cardiovascular complications have also been described in COVID-19 including arterial and venous thrombosis, pulmonary embolism and myocarditis. It is imperative for radiologists to be aware of all the varied faces of this disease on imaging, as they may well be the first physician to suspect the disease. This article aims to review the multimodality imaging manifestations of COVID-19 disease in various organ systems from head to toe.


Subject(s)
COVID-19 , Humans , Radiologists , SARS-CoV-2 , Toes , Tomography, X-Ray Computed
14.
Pediatr Rheumatol Online J ; 19(1): 104, 2021 Jun 30.
Article in English | MEDLINE | ID: covidwho-1292002

ABSTRACT

BACKGROUND: H syndrome (HS) is a rare autoinflammatory disease caused by a mutation in the solute carrier family 29, member 3 (SCL29A3) gene. It has a variable clinical presentation and little phenotype-genotype correlation. The pathognomonic sign of HS is cutaneous hyperpigmentation located mainly in the inner thighs and often accompanied by other systemic manifestations. Improvement after tocilizumab treatment has been reported in a few patients with HS. We report the first patient with HS who presented cardiogenic shock, multiorgan infiltration, and digital ischemia. CASE PRESENTATION: 8-year-old boy born to consanguineous parents of Moroccan origin who was admitted to the intensive care unit during the Coronavirus Disease-2019 (COVID-19) pandemic with tachypnoea, tachycardia, and oliguria. Echocardiography showed dilated cardiomyopathy and severe systolic dysfunction compatible with cardiogenic shock. Additionally, he presented with multiple organ dysfunction syndrome. SARS-CoV-2 polymerase chain reaction (PCR) and antibody detection by chromatographic immunoassay were negative. A previously ordered gene panel for pre-existing sensorineural hearing loss showed a pathological mutation in the SCL29A3 gene compatible with H syndrome. Computed tomography scan revealed extensive alveolar infiltrates in the lungs and multiple poor defined hypodense lesions in liver, spleen, and kidneys; adenopathy; and cardiomegaly with left ventricle subendocardial nodules. Invasive mechanical ventilation, broad antibiotic and antifungal coverage showed no significant response. Therefore, Tocilizumab as compassionate use together with pulsed intravenous methylprednisolone was initiated. Improvement was impressive leading to normalization of inflammation markers, liver and kidney function, and stabilising heart function. Two weeks later, he was discharged and has been clinically well since then on two weekly administration of Tocilizumab. CONCLUSIONS: We report the most severe disease course produced by HS described so far in the literature. Our patient's manifestations included uncommon, new complications such as acute heart failure with severe systolic dysfunction, multi-organ cell infiltrate, and digital ischemia. Most of the clinical symptoms of our patient could have been explained by SARS-CoV-2, demonstrating the importance of a detailed differential diagnosis to ensure optimal treatment. Although the mechanism of autoinflammation of HS remains uncertain, the good response of our patient to Tocilizumab makes a case for the important role of IL-6 in this syndrome and for considering Tocilizumab as a first-line treatment, at least in severely affected patients.


Subject(s)
Cardiomyopathy, Dilated/physiopathology , Hereditary Autoinflammatory Diseases/physiopathology , Ischemia/physiopathology , Multiple Organ Failure/physiopathology , Shock, Cardiogenic/physiopathology , Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19 , Cardiomyopathy, Dilated/diagnostic imaging , Cardiomyopathy, Dilated/therapy , Child , Glucocorticoids/therapeutic use , Hereditary Autoinflammatory Diseases/diagnosis , Hereditary Autoinflammatory Diseases/genetics , Hereditary Autoinflammatory Diseases/therapy , Humans , Ischemia/therapy , Kidney Diseases/diagnostic imaging , Kidney Diseases/physiopathology , Kidney Diseases/therapy , Liver Diseases/diagnostic imaging , Liver Diseases/physiopathology , Liver Diseases/therapy , Lung Diseases/diagnostic imaging , Lung Diseases/physiopathology , Lung Diseases/therapy , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/physiopathology , Lymphadenopathy/therapy , Male , Methylprednisolone/therapeutic use , Multiple Organ Failure/therapy , Nucleoside Transport Proteins/genetics , Pulse Therapy, Drug , Respiration, Artificial , SARS-CoV-2 , Shock, Cardiogenic/therapy , Splenic Diseases/diagnostic imaging , Splenic Diseases/physiopathology , Splenic Diseases/therapy , Toes/blood supply , Tomography, X-Ray Computed , Treatment Outcome
15.
J Allergy Clin Immunol Pract ; 9(8): 3196-3197, 2021 08.
Article in English | MEDLINE | ID: covidwho-1275423
18.
Adv Skin Wound Care ; 34(7): 348-354, 2021 Jul 01.
Article in English | MEDLINE | ID: covidwho-1268079

ABSTRACT

GENERAL PURPOSE: To familiarize wound care practitioners with the differential diagnoses of chilblains-like lesions that could be associated with the complications of COVID-19. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Identify the population most often affected by COVID toes.2. Select the assessments that help differentiate the various conditions that cause chilblains-like lesions.3. Choose appropriate treatment options for the various conditions that cause chilblains-like lesions.


This review article focuses on the pathogenesis, clinical features, and diagnostic testing of the common pathologies that can manifest as chilblains-like lesions. These differentials include "COVID toes," Raynaud phenomenon, acrocyanosis, critical limb ischemia, thromboangiitis obliterans, chilblains associated with lupus erythematosus, and idiopathic chilblains. The authors present a helpful mnemonic, ARCTIC, to assist clinicians in recognition and diagnosis.


Subject(s)
COVID-19/diagnosis , Chilblains/diagnosis , Skin Diseases/diagnosis , COVID-19/complications , Chilblains/pathology , Chilblains/virology , Diagnosis, Differential , Fingers/pathology , Humans , Skin Diseases/pathology , Skin Diseases/virology , Symptom Assessment , Toes/pathology
19.
JAMA Netw Open ; 4(6): e2111676, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1263037
20.
JAMA Netw Open ; 4(6): e2111369, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1263036

ABSTRACT

Importance: Chilblain-like lesions have been one of the most frequently described cutaneous manifestations during the COVID-19 pandemic. Their etiopathogenesis, including the role of SARS-CoV-2, remains elusive. Objective: To examine the association of chilblain-like lesions with SARS-CoV-2 infection. Design, Setting, and Participants: This prospective case series enrolled 17 adolescents who presented with chilblain-like lesions from April 1 to June 30, 2020, at a tertiary referral academic hospital in Italy. Main Outcomes and Measures: Macroscopic (clinical and dermoscopic) and microscopic (histopathologic) analysis contributed to a thorough understanding of the lesions. Nasopharyngeal swab, serologic testing, and in situ hybridization of the skin biopsy specimens were performed to test for SARS-CoV-2 infection. Laboratory tests explored signs of systemic inflammation or thrombophilia. Structural changes in peripheral microcirculation were investigated by capillaroscopy. Results: Of the 17 adolescents (9 [52.9%] male; median [interquartile range] age, 13.2 [12.5-14.3] years) enrolled during the first wave of the COVID-19 pandemic, 16 (94.1%) had bilaterally localized distal erythematous or cyanotic lesions. A triad of red dots (16 [100%]), white rosettes (11 [68.8%]), and white streaks (10 [62.5%]) characterized the dermoscopic picture. Histologic analysis revealed a remodeling of the dermal blood vessels with a lobular arrangement, wall thickening, and a mild perivascular lymphocytic infiltrate. SARS-CoV-2 infection was excluded by molecular and serologic testing. In situ hybridization did not highlight the viral genome in the lesions. Conclusions and Relevance: This study delineated the clinical, histologic, and laboratory features of chilblain-like lesions that emerged during the COVID-19 pandemic, and its findings do not support their association with SARS-CoV-2 infection. The lesions occurred in otherwise healthy adolescents, had a long but benign course to self-resolution, and were characterized by a microvascular remodeling with perivascular lymphocytic infiltrate but no other signs of vasculitis. These results suggest that chilblain-like lesions do not imply a concomitant SARS-CoV-2 infection. Ongoing studies will help clarify the etiopathogenic mechanisms.


Subject(s)
COVID-19 , Chilblains , Skin/pathology , Toes/pathology , Vascular Remodeling , Adolescent , Chilblains/etiology , Chilblains/pathology , Female , Hospitals , Humans , Italy , Lymphocytes/metabolism , Male , Pandemics , Prospective Studies , SARS-CoV-2 , Skin/blood supply , Toes/blood supply
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