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From SARS-CoV-2 hematogenous spreading to endothelial dysfunction: clinical-histopathological study of cutaneous signs of COVID-19.
Patrì, Angela; Vargas, Maria; Buonanno, Pasquale; Annunziata, Maria Carmela; Russo, Daniela; Staibano, Stefania; Servillo, Giuseppe; Fabbrocini, Gabriella.
  • Patrì A; Department of Clinical Medicine and Surgery, Section of Dermatology and Venereology, University of Naples Federico II, Via Pansini 5, Napoli, Italy. patriangela.ap@gmail.com.
  • Vargas M; Department of Neurosciences, Intensive Care Unit, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Napoli, Italy.
  • Buonanno P; Department of Neurosciences, Intensive Care Unit, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Napoli, Italy.
  • Annunziata MC; Department of Clinical Medicine and Surgery, Section of Dermatology and Venereology, University of Naples Federico II, Via Pansini 5, Napoli, Italy.
  • Russo D; Department of Advanced Biomedical Sciences, Pathology Section, University of Naples Federico II, via Pansini 5, Naples, Italy. danielarusso83@yahoo.it.
  • Staibano S; Department of Advanced Biomedical Sciences, Pathology Section, University of Naples Federico II, via Pansini 5, Naples, Italy.
  • Servillo G; Department of Neurosciences, Intensive Care Unit, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini 5, Napoli, Italy.
  • Fabbrocini G; Department of Clinical Medicine and Surgery, Section of Dermatology and Venereology, University of Naples Federico II, Via Pansini 5, Napoli, Italy.
Diagn Pathol ; 16(1): 16, 2021 Feb 25.
Article in English | MEDLINE | ID: covidwho-1105719
ABSTRACT

BACKGROUND:

To date, very few studies on clinical-histopathological correlations of cutaneous disorders associated with COVID-19 have been conducted. CASE PRESENTATION The Case 1 was a 90-year-old man, who tested positive for SARS-CoV-2 from a nasopharyngeal swab. Two days later, he was hospitalized and after eleven days transferred to Intensive Care Unit. A chest CT showed bilateral ground-glass opacities. Just that day, an erythematous maculo-papular rash appeared on trunk, shoulders and neck, becoming purpuric after few days. Histological evaluations revealed a chronic superficial dermatitis with purpuric aspects. The superficial and papillary dermis appeared edematous, with a perivascular lympho-granulocytic infiltrate and erythrocytic extravasation. At intraepithelial level, spongiosis and a granulocyte infiltrate were detected. Arterioles, capillaries and post-capillary venules showed endothelial swelling and appeared ectatic. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Regrettably, due to severe lung impairment, he died. The Case 2 was a 85-year-old man, admitted to Intensive Care Unit, where he was intubated. He had tested positive for SARS-CoV-2 from a nasopharyngeal swab two days before. A chest RX showed bilateral atypical pneumonia. After seven days, a cutaneous reddening involving trunk, upper limbs, neck and face developed, configuring a sub-erythroderma. Histological evaluations displayed edema in the papillary and superficial reticular dermis, and a perivascular lymphocytic infiltrate in the superficial dermis. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Sub-erythroderma as well as respiratory symptoms gradually improved until healing.

CONCLUSIONS:

The endothelial swelling detected in the Case 1 could be a morphological expression of SARS-CoV-2-induced endothelial dysfunction. We hypothesize that cutaneous damage could be initiated by endothelial dysfunction, caused by SARS-CoV-2 infection of endothelial cells or induced by immune system activation. The disruption of endothelial integrity could enhance microvascular permeability, extravasation of inflammatory cells and cytokines, with cutaneous injury. The Case 2 developed a sub-erythroderma associated with COVID-19, and a non-specific chronic dermatitis was detected at histological level. We speculate that a purpuric rash could represent the cutaneous sign of a more severe coagulopathy, as highlighted histologically by vascular abnormalities, while a sub-erythroderma could be expression of viral hematogenous spreading, inducing a non-specific chronic dermatitis.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Parapsoriasis / Skin / Endothelium, Vascular / Dermatitis, Exfoliative / SARS-CoV-2 / COVID-19 Type of study: Case report / Experimental Studies / Prognostic study Topics: Long Covid Limits: Humans / Male Language: English Journal: Diagn Pathol Journal subject: Pathology Year: 2021 Document Type: Article Affiliation country: S13000-021-01075-6

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Parapsoriasis / Skin / Endothelium, Vascular / Dermatitis, Exfoliative / SARS-CoV-2 / COVID-19 Type of study: Case report / Experimental Studies / Prognostic study Topics: Long Covid Limits: Humans / Male Language: English Journal: Diagn Pathol Journal subject: Pathology Year: 2021 Document Type: Article Affiliation country: S13000-021-01075-6