Follow-up of skin lesions during COVID-19: a description of a DRESS case

Brunasso, Alexandra Maria Giovanna; Castellaneta, Marco; Pontali, Emanuele; Raggi, Francesca; Massone, Cesare

doi:10.1007/s00403-020-02171-1

Cited by 5 publications

(5 citation statements)

References 12 publications

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“…SARS-CoV-2 has been reported as a cause of autoimmune manifestations [10-14, 23, 24]. PV was previously associated with viral infections, and the immune mechanism of PV development can be triggered after COVID-19 [21]. These facts suggest that this case can be considered an autoimmune cutaneous post-COVID-19 manifestation.…”

Section: Discussionmentioning

confidence: 78%

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Pemphigus Vulgaris After COVID-19: a Case of Induced Autoimmunity

Medeiros

Neto

França

et al. 2021

SN Compr. Clin. Med.

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Bullae autoimmune diseases can be induced by environmental factors in a genetically susceptible individual, and viruses may be important triggers for this process. Coronavirus disease 2019 (COVID-19) is a multisystemic disease known for developing many types of skin lesions. However, little is known about post-COVID-19 manifestations. A previous healthy male patient, 43 years old, with resistant mediastinal Hodgkin's lymphoma stage II diagnosed in 2019, without treatment at the moment, developed monomorphic flaccid bullae on the trunk 40 days after testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although he had risk factors for IgA and paraneoplastic pemphigus, there were no elements for these diseases. The investigation confirmed a pemphigus vulgaris (PV). PV had a good response to treatment with prednisolone 1 mg/kg per day, and methotrexate 15 mg subcutaneously was added per week. The patient was discharged with oral methotrexate and prednisolone at the same dose. Prednisolone was decreased by 20 mg per day during the follow-up. Viruses such as herpesvirus, cytomegalovirus, and varicela zoster can act as triggers for PV. This process is not immediate after the infection because it depends on the change in antibodies initially produced against the virus that start to identify antigens present in the skin's anchoring structures. SARS-CoV-2 can induce autoimmunity, as seen in Guillán-Barré syndrome and in Kawasaki disease. It is a highly immunogenic virus that is the perfect agent for triggering PV. This case can be considered a cutaneous autoimmune post-COVID-19 manifestation.

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Section: Discussionmentioning

confidence: 78%

“…Environmental triggers can induce bullous autoimmune diseases in a genetically susceptible individual due to molecular mimicry or epitope spreading phenomena [4,21]. The herpesvirus family is a high lymphotropic virus and once again is involved in this association.…”

Section: Discussionmentioning

confidence: 99%

Pemphigus Vulgaris After COVID-19: a Case of Induced Autoimmunity

Medeiros

Neto

França

et al. 2021

SN Compr. Clin. Med.

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“…These patients are particularly prone to classical risk factors for DIHS/DRESS, as they are frequently affected by multiple comorbidities and exposed to several drugs potentially associated with this syndrome. Few isolated cases of DIHS/DRESS in patients with COVID-19 have been described in the literature [ 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 ], but the actual incidence of this condition in patients with SARS-CoV-2 pneumonia is still to be fully explored. In a retrospective cohort analysing 9330 patients hospitalised with COVID-19 from a US healthcare system [ 99 ] between January 2020 and May 2021, six cases of DRESS syndrome were identified, corresponding to an incidence of 6.43 per 10,000 patients.…”

Section: Aetiology and Pathogenesismentioning

confidence: 99%

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses

et al. 2023

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Drug reaction with eosinophilia and systemic symptoms (DRESS) is a heterogeneous, multiorgan and potentially life-threatening drug-hypersensitivity reaction (DHR) that occurs several days or weeks after drug initiation or discontinuation. DHRs constitute an emerging issue for public health, due to population aging, growing multi-organ morbidity, and subsequent enhanced drug prescriptions. DRESS has more consistently been associated with anticonvulsants, allopurinol and antibiotics, such as sulphonamides and vancomycin, although new drugs are increasingly reported as culprit agents. Reactivation of latent infectious agents such as viruses (especially Herpesviridae) plays a key role in prompting and sustaining aberrant T-cell and eosinophil responses to drugs and pathogens, ultimately causing organ damage. However, the boundaries of the impact of viral agents in the pathophysiology of DRESS are still ill-defined. Along with growing awareness of the multifaceted aspects of immune perturbation caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the ongoing SARS-CoV-2-related disease (COVID-19) pandemic, novel interest has been sparked towards DRESS and the potential interactions among antiviral and anti-drug inflammatory responses. In this review, we summarised the most recent evidence on pathophysiological mechanisms, diagnostic approaches, and clinical management of DRESS with the aim of increasing awareness on this syndrome and possibly suggesting clues for future research in this field.

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“…The second hypothesis is reactivation of a previous viral infection. 9,19–22 In our 5 cases, herpes-like inclusions were found in the epidermis, and 2 of them had a history of herpes simplex virus/varicella-zoster virus infection when the anamnesis was questioned in detail. In 1 study, 15 of 53 patients who were positive for COVID-19 (positive nasopharyngeal swab for SARS-CoV-2) and had vesicular skin rashes were diagnosed with herpes.…”

Section: Discussionmentioning

confidence: 76%

Histopathological and Clinical Analysis of Skin Rashes in Children With Multisystem Inflammatory Syndrome Associated With COVID-19

Yüksel¹,

Demirkan²,

Çomut³

et al. 2022

The American Journal of Dermatopathology

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Introduction:A new entity, which occurs a few weeks after SARS-CoV-2 infection and resembling incomplete Kawasaki disease or toxic shock syndrome, has been defined and named multisystem inflammatory syndrome (MIS-C) associated with COVID-19 in children. The aim of our study was to describe histopathological characteristics of skin lesions of MIS-C patients to reveal whether there is a relationship between histopathological features and clinical manifestations.Materials and Methods:Seventeen who had skin involvement of 57 patients who were diagnosed with MIS-C between December 2020 and February 2021 were included in this prospective study. Demographic information, laboratory findings, and patients' managements were recorded. Skin biopsies were taken simultaneously of each patient. Formalin-fixed, paraffin-embedded skin samples were examined microscopically.Results:The rate of skin rash was 30% in patients with MIS-C and was predominantly the maculopapular type. The anatomical distribution of the rash was evaluated as localized in 10 and generalized in 7 patients. In patients with myocarditis, C-reactive protein and fibrinogen were found to be significantly higher, and lymphocyte and albumin values were found to be low. Herpes-like inclusions were found in the microscopic examination of 2 patients with a history of zona zoster in themselves or in their mother. There was a significant difference between keratinocyte necrosis and some clinical parameters.Discussion:Localized skin lesions appear to be associated with a more severe inflammatory.

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Follow-up of skin lesions during COVID-19: a description of a DRESS case

Cited by 5 publications

References 12 publications

Pemphigus Vulgaris After COVID-19: a Case of Induced Autoimmunity

Pemphigus Vulgaris After COVID-19: a Case of Induced Autoimmunity

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): Focus on the Pathophysiological and Diagnostic Role of Viruses

Histopathological and Clinical Analysis of Skin Rashes in Children With Multisystem Inflammatory Syndrome Associated With COVID-19

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