Foot manifestations in a patient with COVID-19 and Epstein-Barr virus: A case study

Nirenberg, Michael S.; Herrera, María del Mar Ruiz

doi:10.1016/j.foot.2020.101707

Cited by 8 publications

(21 citation statements)

References 16 publications

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“…EBV reactivation is known to induce a diverse set of rashes and skin lesions that include urticaria [ 29 ], granuloma annulare [ 30 ], folliculitis [ 31 ], cryoglobulinemia [ 32 , 33 ], and Raynaud’s phenomenon [ 34 ], which resembles COVID toes [ 35 ]. One of the earliest documented cases of COVID toes was described in Madrid, Spain by Nirenberg et al in April 2020 in a 16-year-old female who had a coinfection of EBV and COVID-19 [ 36 ]. A wide variety of skin manifestations were reported by nine subjects among our study groups who tested positive for EBV reactivation, including two who experienced COVID toes: one at four months and the other at nine months post-diagnosis of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation

Gold¹,

et al. 2021

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Coronavirus disease 2019 (COVID-19) patients sometimes experience long-term symptoms following resolution of acute disease, including fatigue, brain fog, and rashes. Collectively these have become known as long COVID. Our aim was to first determine long COVID prevalence in 185 randomly surveyed COVID-19 patients and, subsequently, to determine if there was an association between occurrence of long COVID symptoms and reactivation of Epstein–Barr virus (EBV) in 68 COVID-19 patients recruited from those surveyed. We found the prevalence of long COVID symptoms to be 30.3% (56/185), which included 4 initially asymptomatic COVID-19 patients who later developed long COVID symptoms. Next, we found that 66.7% (20/30) of long COVID subjects versus 10% (2/20) of control subjects in our primary study group were positive for EBV reactivation based on positive titers for EBV early antigen-diffuse (EA-D) IgG or EBV viral capsid antigen (VCA) IgM. The difference was significant (p < 0.001, Fisher’s exact test). A similar ratio was observed in a secondary group of 18 subjects 21–90 days after testing positive for COVID-19, indicating reactivation may occur soon after or concurrently with COVID-19 infection. These findings suggest that many long COVID symptoms may not be a direct result of the SARS-CoV-2 virus but may be the result of COVID-19 inflammation-induced EBV reactivation.

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Section: Discussionmentioning

confidence: 99%

Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation

Gold¹,

et al. 2021

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“…6,15 Most reports have been in white people, with rare reports in Hispanic and Black people. 16 No cases have been reported in a large series from China. 17 Secondary chilblain LE was ruled-out in our study because of negative ANA and DIF studies and the absence of other features of chronic cutaneous LE.…”

Section: Discussionmentioning

confidence: 99%

A clinicopathological description of COVID‐19‐induced chilblains (COVID‐toes) correlated with a published literature review

et al. 2021

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Background: The abundance of publications of COVID-19-induced chilblains has resulted in a confusing situation. Methods: This is a prospective single-institution study from 15 March to 13 May 2020. Thirty-two patients received PCR nasopharyngeal swabs. Of these, 28 patients had a thoracic CT-scan, 31 patients had blood and urine examinations, 24 patients had skin biopsies including immunohistochemical and direct immunofluorescence studies, and four patients had electron microscopy. Results: COVID-19-induced chilblains are clinically and histopathologically identical to chilblains from other causes. Although intravascular thrombi are sometimes observed, no patient had a systemic coagulopathy or severe clinical course. The exhaustive clinical, radiological, and laboratory work-up in this study ruled-out other primary and secondary causes. Electron microscopy revealed rare, probable viral particles whose core and spikes measured from 120 to 133 nm within endothelium and eccrine glands in two cases. Conclusion: This study provides further clinicopathologic evidence of COVID-19-related chilblains. Negative PCR and antibody tests do not rule-out infection. Chilblains represent a good prognosis, occurring later in the disease course. No systemic coagulopathy was identified in any patient. Patients presenting with acral lesions should be isolated, and chilblains should be distinguished from thrombotic lesions (livedo racemosa, retiform purpura, or ischemic acral necrosis).

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“…Neurological manifestations in the lower extremities and foot were related to Guillain-Barré syndrome associated with patients with acute symptoms of COVID-19. Guillain-Barré syndrome can lead to paresis, muscle weakness in the lower extremities (the most common neurological manifestation), and paralysis [11,12]. This syndrome usually occurred 10-21 days after COVID-19 diagnosis.…”

Section: Neurological Systemmentioning

confidence: 99%

“…This syndrome usually occurred 10-21 days after COVID-19 diagnosis. Patients often had paresis, lower limb areflexia, hypoparesis, muscle weakness, ataxia, and difficulty walking [10][11][12]. Table 4 shows the clinical manifestations of COVID-19 in the foot.…”

Section: Neurological Systemmentioning

confidence: 99%

“…It has been argued that in some patients positive for COVID-19 (COVID-19+) there are widespread manifestations at the skin level or in isolation in lower limbs and/or feet [2,[11][12][13][14][15]. Different authors agree that in children and young adults with suspected COVID-19 infection, reddish purple nodules have been observed on the toes, similar in appearance to pernio erythema or chilblains ("COVID toes") [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Manifestations of COVID-19 in the Feet: A Review of Reviews

Jiménez-Cebrián

Castro-Méndez

García-Podadera

et al. 2021

JCM

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There is a lack of scientific evidence about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical manifestations are not thoroughly understood; classically, the virus manifests itself at the pulmonary level but can manifest at other levels. To the best of our knowledge, systematic reviews and non-systematic reviews about COVID-19 symptoms in the feet have not been published. The aim of this review of reviews was to analyze and synthesize the published reviews on manifestations of COVID-19 at the foot level. Methods: a review of reviews was conducted; the eligibility criteria included studies published in English or Spanish, involving children and adults with COVID-19, and reporting foot manifestations. PubMed, SciELO, Science Direct, Cochrane Database of Systematic Review, and Google Scholar were analyzed. Two authors independently performed the screening and quality assessment of the studies with AMSTAR 1, and finally, nine reviews were analyzed (one systematic and eight narratives studies). The main clinical manifestations at the foot level in patients with COVID-19 were vascular (edema, exanthems, chilblains, ischemia, and distal necrosis), dermatological (vesicular, maculopapular, papulosquamous, urticarial skin breakouts, and recurrent herpes), and neurological (muscular weakness in lower limbs, paresis, areflexias, ataxia, and difficulty walking). Erythema pernio or “COVID toes” was shown as the most characteristic lesion of this disease, especially in asymptomatic children and young people, so this typical manifestation may be considered important in patients who are positive for COVID-19. This finding does not allow for strong conclusions due to the scarce literature and methodological quality in this regard. Future studies are necessary.

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Foot manifestations in a patient with COVID-19 and Epstein-Barr virus: A case study

Cited by 8 publications

References 16 publications

Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation

Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation

A clinicopathological description of COVID‐19‐induced chilblains (COVID‐toes) correlated with a published literature review

Clinical Manifestations of COVID-19 in the Feet: A Review of Reviews

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