Cutaneous manifestations of hospitalized coronavirus disease 2019 patients: a report of six cases with clinicopathologic features and viral RNA in situ hybridization

Abstract

Acute genital vulvar ulcerations are non-sexually acquired lesions characterized by sudden onset of a few genital ulcers, presented typically in girls and young women. The terms AGU or Lipsch€ utz ulceration are used to describe ulcers associated with an immunologic reaction to a distant source of infection or inflammation. 6 The most common triggering factors are infectious diseases, specially flu-like and mononucleosis syndrome infections. 5,7 In many cases, the patients present also other symptoms, mainly oral aphthae, malaise, lymphadenopathy or fever, 8 and concomitant cutaneous manifestations such as erythema nodosum can also be observed. 6 Therapies for AGU include anti-inflammatory drugs, topical anaesthetics and corticosteroids. When a triggering infection is documented, antimicrobial agents are also useful for the management of the ulcerations. The lesions commonly resolve within 3 weeks. Some virus species have been well defined as triggering agents of Lipsch€ utz ulcers, specially Epstein-Barr virus. Although SARS Coronavirus 2 has been associated with oral ulcers, 9 we did not find previous reports of coronavirus-related AGU in the English literature. We report this case in order to describe a potential reactive dermatologic manifestation of the COVID-19. Moreover, we propose that Lipsch€ utz ulcers could be triggered by SARS Coronavirus 2, comparably to other respiratory virus infections. Acknowledgement The patients in this manuscript have given written informed consent to the publication of their case details.

The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 – A systematic review of the literature

“… N.A. [ 317 ] Chilblain-like lesions 11 M, 6 F 32 N.A. [ 318 ] Livedo reticularis F 62 Heparin [ 319 ] Urticarial skin rash, Chilblain-like lesions 1 F, 1 M F 59.5 1 Glucocorticoids, antihistamines N.A.…”

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19) – anatomic pathology perspective on current knowledge

“…Viral detection by immunohistochemical and in situ hybridization asssays SARS-CoV-2 viral protein can be detected in the tissue specimens using virus-specific antibodies and targeting viral RNA by in situ hybridization techniques [56,59,[85][86][87]. Researchers have demonstrated in situ expression of SARS-CoV-2 in the airways and lung in the deceased COVID-19 individuals.…”

Unilateral deep vein thrombosis with gangrene involving the ascending aorta with sepsis and pulmonary thromboembolism—a pertinent cutaneous marker of severity of COVID‐19

“…Most of these manifestations were seen with the infection though in some it preceded the onset of COVID‐19 symptoms 4 . While some unusual manifestations have been recently reported like exfoliative shock syndrome, COVID‐19‐induced rash and mucositis (CIRM), and calciphylaxis with thrombotic vasculopathy, notably viral mRNA was not detected using RNA ISH for SARS‐CoV‐2, suggesting that cutaneous manifestations associated with COVID‐19 are secondary to dysregulation of the immune and coagulation pathways rather than direct viral skin toxicity 5 …”