Histologic features of long‐lasting chilblain‐like lesions in a paediatric COVID‐19 patient

Locatelli, Andrea; Test, Elisa Robustelli; Vezzoli, Pamela; Carugno, Andrea; Moggio, Erica; Consonni, L.; Gianatti, Andrea; Sena, Paolo

doi:10.1111/jdv.16617

Cited by 52 publications

(91 citation statements)

References 17 publications

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“…The varied cutaneous presentations, histopathological ndings, and other details are tabulated in table 3. Reference [16], [19], [20], [21], [24], [25], [26], [27] [17], [18], [ The majority of the children showed erythematous maculopapular eruptions, which is generally the commonest cutaneous presentation in any viral illness, however, a closer look in our study subjects throws up several contradicting observations. For instance, instead of general cephalocaudal distribution in any viral exanthem, here the cases showed involvement of acral region of feet and hands.…”

Section: Resultsmentioning

confidence: 87%

“…[11], [12] [13], [14] [15] Thus, a total of 13 articles met the inclusion criteria and were systematically reviewed. Out of that 5 were case series, [16], [17] [18], [19] [20] 4 were case reports, [21], [22] [23], [24] and 4 were original studies. [25], [26] [27], [28] Maximum number of articles were reported from Italy, [16], [19] [20], [21] [22], [24] [26] followed by Spain, [17] [23], [25] France, [8] Turkey, [28] and USA.…”

Section: Resultsmentioning

confidence: 99%

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Cutaneous manifestations associated with COVID-19 in children: A Systematic Review

Shah

Akhade

Ganguly

et al. 2020

Preprint

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Background: Cutaneous manifestation of COVID 19 in children has not yet been reviewed systematically and hence this review gives a future direction to the clinicians to be vigilant for skin presentations during such pandemic.Methodology: The review was done as per the guidelines of PRISMA and literature search was done on PubMed database using keywords as COVID-19, children and skin in different combinations. Articles published in English with cases of age 1 month to 18 years were eligible. The outcome included varied aspects of cutaneous and COVID-19 infection. The review protocol was not registered.Results: Of 51 publications identified, 13 studies containing 149 children met the eligibility criteria. Acrally located erythematous maculopapular lesion was the most common finding in 138 children. Erythema multiforme, varicella like exanthem and Kawasaki disease like presentations were reported in the rest of the cases. The duration of the skin lesion was 1-2 weeks in 43%. Skin biopsy done in 18 cases revealed superficial & deep perivascular and peri-eccrine lymphocytic infiltrate & lymphocytic vasculitis. RT-PCR was positive in 13.8% cases. Serological markers for HSV, parvovirus B19 analyzed across various studies, were found negative, except for mycoplasma pneumoniae in 2 of 20 cases tested.Discussion: Clinicopathologic analysis established chilblains like lesion in 43% cases with no confirmed etiology like cold exposure, autoimmune dysfunction, drug reaction, or viral infection. The usual cephalo-caudal spread of a viral exanthem was also missing. However, a low number of discussed cases was a limitation of the study.Conclusion: In the absence of any confirmed etiology for such cutaneous manifestations, the possibility of COVID-19 should be explored and evaluated thoroughly during such pandemic.

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Section: Resultsmentioning

confidence: 87%

Section: Resultsmentioning

confidence: 99%

Cutaneous manifestations associated with COVID-19 in children: A Systematic Review

Shah

Akhade

Ganguly

et al. 2020

Preprint

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“…The characteristics of skin lesions in patients with COVID-19, as described recently in case reports or case series, are summarized in the Table 1 [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ,…”

Section: Introductionmentioning

confidence: 99%

Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature

2020

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In recent weeks, several reports have emerged of skin lesions with different clinical presentations in COVID-19 cases. All dermatologists should be aware of these cutaneous lesions, which may be early clinical symptoms of infection. We reviewed the literature on cutaneous manifestations in the PubMed database from December 2019 and June 2020. From the cases described as case reports or series in 57 recent articles, it appears that skin lesions (i) are highly varied, (ii) may not be related to the severity of the condition and (iii) resolve spontaneously in a few days. The frequency of these lesions in COVID-19 patients varies between 1.8% and 20.4%. The major clinical forms described were maculopapular eruptions, acral areas of erythema with vesicles or pustules (pseudochilblain), urticarial lesions, other vesicular eruptions and livedo or necrosis. The lesions were mainly localized in the trunk and extremities. The majority of patients were male, aged between 4.5 and 89 years. A minority of the patients were children presenting with acral, chilblain-like lesions, papulo-vesicular eruptions or Kawasaki disease-like pediatric inflammatory multisystem syndrome. The mean duration of the lesions was a few days, but some lasting as little as 20 min and others as long as four weeks have been reported. The mean latency time in the majority of cases was between 1 and 14 days; however, in some patients, lesions appeared 2 to 5 days before the onset of COVID-19 symptoms. The histopathological features of these lesions also vary, corresponding to the diversity of clinical manifestations. These features underline the nature of epidermal and dermal vascular lesions—and in severe cases, microvascular injury and thrombosis—associated with COVID-19, and provide important clues to their pathological mechanisms.

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“…Reports of "pseudo-chilblains" have also emerged from other studies of COVID-19 patients [205,206]. In one such case, the histology was similar to other chilblains of unknown cause, with edema of the papillary dermis and perivascular/peri-eccrine lymphocytic infiltrates but no evidence of endothelial cell damage [207]. The most common manifestation (47%) consisted of non-distinctive maculopapular lesions, which have many causes.…”

Section: Cutaneous Diseasementioning

confidence: 82%

Vasculopathy and Coagulopathy Associated with SARS-CoV-2 Infection

Labò

Ohnuki

Tosato

2020

Cells

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The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has resulted in >500,000 deaths worldwide, including >125,000 deaths in the U.S. since its emergence in late December 2019 and June 2020. Neither curative anti-viral drugs nor a protective vaccine is currently available for the treatment and prevention of COVID-19. Recently, new clinical syndromes associated with coagulopathy and vasculopathy have emerged as a cause of sudden death and other serious clinical manifestations in younger patients infected with SARS-CoV-2 infection. Angiotensin converting enzyme 2 (ACE2), the receptor for SARS-CoV-2 and other coronaviruses, is a transmembrane protein expressed by lung alveolar epithelial cells, enterocytes, and vascular endothelial cells, whose physiologic role is to induce the maturation of angiotensin I to generate angiotensin 1-7, a peptide hormone that controls vasoconstriction and blood pressure. In this review, we provide the general context of the molecular and cellular mechanisms of SARS-CoV-2 infection with a focus on endothelial cells, describe the vasculopathy and coagulopathy syndromes in patients with SARS-CoV-2, and outline current understanding of the underlying mechanistic aspects.

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Histologic features of long‐lasting chilblain‐like lesions in a paediatric COVID‐19 patient

Abstract: 3 Chen D, Yang H, Cao Y et al. Expert consensus for managing pregnant women and neonates born to mothers with suspected or confirmed novel coronavirus (COVID-19) infection.

Cited by 52 publications

References 17 publications

Cutaneous manifestations associated with COVID-19 in children: A Systematic Review

Cutaneous manifestations associated with COVID-19 in children: A Systematic Review

Clinical and Histopathological Features and Potential Pathological Mechanisms of Skin Lesions in COVID-19: Review of the Literature

Vasculopathy and Coagulopathy Associated with SARS-CoV-2 Infection

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