A clinicopathological description of COVID-19-induced chilblains (COVID-toes) correlated with a published literature review.
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).Keywords
COVID-19; COVID-toes; CT-scan; chilblains; coagulation; coagulopathy; direct immunofluorescence study; electron microscopy; histopathology; hypercoagulable; immunohistochemistry; interferon; livedo racemosa; lupus erythematosus; paraviral; retiform purpura; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); thrombi
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Toes
/
Chilblains
/
COVID-19
Type of study:
Cohort study
/
Diagnostic study
/
Observational study
/
Prognostic study
/
Reviews
Topics:
Long Covid
Limits:
Adolescent
/
Adult
/
Aged
/
Child
/
Female
/
Humans
/
Male
/
Middle aged
/
Young adult
Language:
English
Journal:
J Cutan Pathol
Year:
2022
Document Type:
Article
Affiliation country:
Cup.14099
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