Granuloma annulare triggered by SARS‐CoV ‐2 infection: Immunohistochemical staining

Abstract

Several skin lesions have been associated with COVID-19, some of them classically related to other microbiological agents. 1 Recently, positivity for SARS-CoV/SARS-CoV-2 virus spike protein has been reported by immunohistochemistry (IHC) in skin biopsies from patients with erythema multiforme-like lesions or chilblains associated with COVID-19. 2,3 Granuloma annulare (GA) can be triggered by different viruses such as the Epstein-Barr virus (EBV), HIV, and hepatitis B and C. 4 Previously, we reported one patient with localized GA triggered after a SARS-CoV-2 infection. 5 Additionally, immunohistochemical staining and reverse transcription polymerase chain reaction (RT-PCR) techniques for SARS-CoV-2 detection

The case of granuloma annulare associated with SARS‐CoV ‐2 infection

“…GA is thought to occur with the activation of the immune system triggered by the virus, rather than the direct effect of the virus on the skin. 3 In our patient, the lesion disappeared within 10 days following the skin biopsy. Therefore, the virus could not be detected through a PCR test or immunohistochemical study by performing fresh skin biopsy from the skin.…”

“…But two different articles have been published about the same case. 2 , 3 Here, a case of localized GA that appeared on the dorsum of the foot on the tenth day of a COVID‐19 infection is presented.…”

“…With this second report, the SARS‐CoV‐2 specific RT‐PCR result performed on the fresh skin biopsy sample of the case was negative. 3 In addition, they determined that the viral spike protein showed positive staining in a granular pattern in the cytoplasm of histiocytes in the lesion using immunohistochemical methods. However, they reported the same positive staining pattern was also observed in two SARS‐CoV‐2 negative patients who were examined as control cases.…”

Granuloma Annulare: An Updated Review of Epidemiology, Pathogenesis, and Treatment Options

“…GA in the setting of viral infections has also been noted, with Epstein–Barr virus [ 44 ], human immunodeficiency virus [ 21 ], and varicella zoster virus (VZV) [ 45 , 46 ] being recently reported. Two cases of GA triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have also been described [ 47 , 48 ].…”

A rare case of reactive granulomatous dermatitis during COVID‐19: a possible role of cephalosporine and potential mechanisms

“…1,2 Clinical variants of PG include ulcerative, bullous, pustular, vegetative and peristomal. 1,2 There have been various cutaneous reactions reported after COVID-19 vaccination. However, to our knowledge, there has been no COVID-19 vaccination-associated PG reported.…”