Dear Editor, Reports on COVID-19 in children are limited. Despite new data emerging, and understanding of the disease improves rapidly, there are as yet several features and complications related to the disease that remain unknown. Herein, we report the first case of a child with chilblains and retinal vasculitis related to COVID-19. An 11-year-old patient arrived at the Dermatology Emergency Department with a 2-week history of asymptomatic plaques on his toes. He did not complain of fever, respiratory symptoms (as cough or dyspnoea), headache, malaise, sore throat, nasal congestion or diarrhoea. He had no history of family exposure, and he was taking strict social distancing measures due to the Spanish Government restrictions applied on 13 March 2020. Physical examination showed oedematous and erythematous to violaceous plaques on the dorsal toes of both feet (Fig. 1). These lesions were clinically compatible with chilblains. A nasopharyngeal sample was obtained, and a reverse transcription polymerase chain reaction (RT-PCR) was negative for SARS-CoV-2. Serologic tests (both immunochromatographic and chemiluminescence immunoassay) showed negative SARS-CoV-2 IgM with positive IgG antibodies. Complementary studies, including Author contributions Drs Quintana-Castanedo Feito-Rodr ıguez and Mayor-Ibarguren conceptualized and designed the study, coordinated and drafted the initial manuscript, and reviewed and revised the manuscript. Drs Fern andez-Alcalde, Granados-Fern andez, Montero-Vega and de Lucas-Laguna designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

The term Mycoplasma pneumoniae-induced rash and mucositis (MIRM) was recently proposed to identify the mucocutaneous condition secondary to M. pneumoniae infection that had historically been regarded among the more confusing pathologies of erythema multiforme and Stevens-Johnson syndrome. Based on a number of previous reports, these syndromes require differentiation since they have different prognoses and specific treatment requirements. We report a case of oral and genital erosions that strongly resembled MIRM without rash but were found to be secondary to a Chlamydia pneumoniae infection. After a thorough review of the literature on this subject, we propose that C. pneumoniae should also be considered a potential causative agent of MIRM and that this term should be amended to include C. pneumoniae infection.

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BACKGROUND AND OBJECTIVES:There is no consensus on optimal treatment duration for propranolol in infantile hemangioma (IH). We evaluated the efficacy and safety of oral propranolol solution administered for a minimum of 6 months up to a maximum of 12 months of age in high-risk IH. METHODS:This single-arm, open-label, phase 3 study was conducted in patients aged 35 to 150 days with high-risk IH in 10 hospitals between 2015 and 2017. The study comprised a 6-month initial treatment period (ITP) plus continuation up to 12 months of age if complete success was not achieved, a follow-up, and a retreatment period. Patients received oral propranolol twice daily (3 mg/kg per day). The primary end point was the success rate at the end of the ITP. Furthermore, the persistence of IH response and efficacy of retreatment was evaluated. RESULTS:The success rate after 6 months of treatment was 47%, increasing to 76% at the end of the ITP. Of the patients who achieved success, 68% sustained success for 3 months without treatment, and 24% required retreatment. Of the 8 patients who were retreated, 7 achieved success. Adverse events, reported by 80% of patients, were mild, which were expected in this population or known propranolol side effects. CONCLUSIONS:Oral propranolol administered beyond 6 months and up to 12 months of age meaningfully increases the success rate in high-risk IH. Success was sustained in most patients up to 3 months after stopping treatment. Retreatment was efficacious, and the safety profile satisfactory.abstract

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