Erythema Gyratum Repens: A Delayed Manifestation of COVID-19 Infection

Abstract

A man in his mid 50’s with a history of recent COVID-19 infection presented to the emergency department (ED) with a cough, chest pain, shortness of breath, and a new rash. Workup included a complete blood count and computed tomography (CT) scan of the thorax, which showed neutrophilic leukocytosis and multiple cavitary lesions in the right lung and superior segment of the left upper lobe. Physical examination showed serpiginous, erythematous plaques on the lower extremities, upper extremities, abdomen, and back. Initially, erythema gyratum repens (EGR) secondary to tuberculosis was considered. However, QuantiFERON-TB Gold testing was negative and bronchiolar lavage fluid grew methicillin-resistant staph aureus (MRSA). Further testing for other etiologies was unremarkable. Due to the characteristic pattern of the rash and resolution shortly after COVID-19 symptoms subsided, a diagnosis of EGR secondary to COVID-19 infection was made.