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Introduction Various cutaneous manifestations of COVID-19 have been described and awareness of these findings is beneficial for clinicians for an accurate diagnosis. Clinical Findings We present a case of skin findings consistent with acral microthrombi induced changes in an elderly gentleman who was positive for COVID-19. Outcomes The patient had a mild course of COVID-19. Cutaneous findings resolved after one week from presentation with supportive care. Conclusions This case highlights the importance of awareness of manifestations of COVID-19, which may assist in timely diagnosis and prevention of transmission.

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A 46-year-old woman with no dermatologic history presented to the dermatologist with a complaint of an enlarging, painful, and ulcerating bullous plaque on the left hand (Fig 1), present for 3 weeks. The patient worked as a cashier and owned livestock, including horses, cattle, and chickens. No drainage, other areas of involvement, or contacts with similar lesions were noted. She denied any injury to the area before the development of the lesion; however, she reported that an unsuccessful incision and drainage was attempted at a recent emergency department visit. Gram stain result from the previous incision and drainage was negative. A shave biopsy was obtained, with hematoxylin-eosin staining (Fig 2). Question 1: What is the most likely diagnosis? A. Squamous cell carcinoma (SCC) B. Ecthyma contagiosum (orf) C. Cutaneous anthrax