Immunological and virological profile of children with chilblain-like lesions and SARS-CoV-2

ABSTRACT

Objectives: In this study we tried to assess a possible correlation between the paediatric dermatological manifestations and the SARS-CoV-2, using for the first time 3 different tests. Method: From April to June 2020, minors with recent skin manifestations and symptoms of COVID-19, themselves or any of first-degree relatives, were enrolled. Epidemiological and clinical information, and biological results including 3 types of SARS-CoV-2 tests [nasal PCR (systemic symptoms within the past 48 hours), serology (IgG, Abbott ARCHITECT), and IFN-γ-ELISPOT-assay] were collected. Results: Thirty patients (20 boys, average 9.5 years) and 37 symptomatic first-degree relatives were enrolled. Seventeen patients presented with chilblains (Figure 1) occurring before (n = 2, average 19 days), simultaneously (n = 2, 12%) or after systemic manifestations (60%, average 22 days). Spontaneous resolution was complete in 27 days (10-50) in 11/17 patients. Elevated CRP and/or increased inflammatory cytokines were noted in 11 children (37%) including 8/17 with chilblains (47%) mostly TNF-α, IL-1, type 1 IFN and IL-6. Biological inflammation was not correlated with time lapses from cutaneous or systemic symptoms to the blood test, or with severity of chilblains. The 3/3 PCR, the 10/10 IFN-γ-ELISPOT-assay and the 15/16 serology were negative. Dicussion A cytokine storm was described in adults with COVID-19 and in the paediatric inflammatory multisystem syndrome temporally associated with SARS-COV-2 infection elevated CRP and IL-6 levels. The peak of incidence of COVID-19 and the reported chilblains occurred simultaneously. Only 1/16 serology in children with chilblains was positive. Its sensitivity varies from 100 to 85% in severe or mild symptomatic patients respectively. We confirmed the COVID-19 only once, using 3 different methods. This result might reflect the estimated prevalence of seropositivity for SARS-CoV-2 in the general French population. While epidemiological data, clinical manifestations and elevated cytokines level suggest an association with SARS-CoV-2, no evident link could have been made here.