PSEUDOPERNIOSIS AS A LATE MANIFESTATION after SARS2-COD19 INFECTION. A PURPOSE of A SERIES of 19 CASES

ABSTRACT

Background: In winter, you can usually see a picture of Perniosis and/or chilblains. Painful, often itchy, red-to-purple lesions that affect the acrid surfaces of the fngers and toes after contact with the cold, resembling vasculitis, characterize them. Chilblains can be idiopathic and self-limiting or associated with systemic diseases. The diagnosis is usually clinical, but in some circumstances, analytical and microscopic studies of a biopsy sample may be necessary. We present a series of 19 consecutive cases of Pseudoperniosis associated with probable past INFECTION by SARS-CoV-2. Methods: During the winter 2020-21, an unexpected number of cases referred as 'acute arthritis/vasculitis' have been received in our rheumatology section and associated consultations. In the pathochrony of patients, exposure to cold was referred to as the main triggering factor. Initially qualifed as PERNIOSIS. Given the appearance in the current situation of Pandemic by covid-19, we began to request the serology SARS2-COVID19 IgG/IgM. Appreciating an approximate rate of 70% of IgG+ positivity in which it was performed. Results: Characteristics of the clinical data collected evolutionarily in the 19 patients These are preferably young people, without any other pathology, although there are also people of all ages, with a clinical picture of edema of soft parts preferably of the hands, but also in the feet, with pain and some hemorrhage infusions, including ulcerations in the areas of the knuckles or pressure (PHOTO1-2-3). Despite the overwhelming nature of the picture, they do not associate any other symptoms and the analyses are normal, including acute phase reactants (ESR and PCR), and serological markers of autoimmune disease. Approximately 1/4 of them reported having passed clinical compatible with the covid19 infection and/or having been isolated with some minor symptom, but they had not been performed PCR. The others did not report any symptoms associated with COD19 infection. From the initial diagnosis, about 40 days passed on average. Many of them were being treated with corticosteroids/NSAIDs without improvement. In the ultrasounds performed, only edema of periarticular and paratendinous tissue is appreciated, such as that which can occur after a momentary ischemic picture. All evolved favorably avoiding cold (probable triggering factor), and with antiplatelet agent (infant aspirin). Conclusion: This picture of Pseudoperniosis lacks the typical pruritus of perniosis and the main problem is pain along with edema of the tissues of the hand that leads to make it impossible to use. Similarly, asymmetric lesions similar to perniosis were observed in patients who presented skin manifestations of SARS-CoV-2 infection in a study conducted in Spain (1). We are following these patients to assess if there is any relationship with any other factor that facilitates this unusual incidence, and at the same time indicate the transience of the clinical picture that evolves favorably in a few weeks.