Response to ‘No evidence of SARS‐CoV‐2 infection by polymerase chain reaction or serology in children with pseudo‐chilblain’

Abstract

We read with interest the article by Caselli D et al., reporting a case series of 38 children with chilblain‐like lesions (CLL). Testing for SARS‐CoV‐2, including PCR, rapid test serology and ELISA method for IgA and IgG antibodies yielded negative results in all cases. They concluded that their data do not allow them to support the relationship of CLL with SARS‐CoV‐2 infection. So far, data in the literature studying CLL documented a very low percentage of laboratory confirmed SARS‐CoV‐2. However, Colmenero and colleagues were able to detect SARS‐CoV‐2 in endothelial cells of cutaneous chilblain lesions by immunohistochemistry methods in 7 pediatric patients with negative nasopharyngeal swabs.

Chilblains-Like Lesions in Pediatric Patients: A Review of Their Epidemiology, Etiology, Outcomes, and Treatment

“…Reports of chilblains-like lesions began to appear in the literature at the onset of the SARS-CoV-2 pandemic and were suspected to be a result of the viral infection. However, of the patients reported, the majority were negative for SARS-CoV-2: in sum, 499 patients tested negative (47.12%), 64 patients had positive tests (6.04%), and 496 patients were not tested or the data was unavailable (46.84%) as noted in Table 2 ( 6 , 10 – 57 ).…”

“…Eight lesions were macules or patches, 6 were reported as nodules, 1 was papulopustular, and 1 was reported as palpable ( 23 , 30 , 33 , 35 , 38 ). One hundred and fifty-six lesions were reported as chilblain or chilblain-like ( 14 , 18 , 25 , 33 , 48 – 50 , 56 , 57 ). Six were described as dusky ( 6 , 19 , 20 , 55 ).…”

“…Though some lesions were asymptomatic, there were reports of pain in 334 cases and pruritis in 335 cases both prior to and with the onset of the lesions ( 6 , 11 – 15 , 17 – 20 , 23 – 25 , 27 – 30 , 32 – 38 , 40 , 42 , 44 , 46 , 48 , 50 , 51 , 53 – 55 , 57 ). In nine cases, pain, pruritis, and swelling were reported together ( 22 ).…”

“…However, there have been reports of systemic symptoms occurring prior to, concurrent with, or following the appearance of chilblains-like lesions. The most common symptoms were fever (116), cough (80), diarrhea/gastrointestinal symptoms ( 54 ), and sore throat ( 6 , 11 – 16 , 18 – 20 , 22 , 24 – 28 , 30 – 34 , 36 – 38 , 41 – 44 , 48 , 50 – 53 , 55 , 57 ) Supplementary Table S3 . Additional symptoms included rhinorrhea in 34 cases, malaise in 18 cases, myalgias in 16 cases, COVID-like symptoms in 14 cases, headache in 12 cases, unspecified respiratory symptoms in 11 cases, cough or rhinorrhea in 11 cases, influenza-like symptoms in 10 cases, rhinitis in nine cases, ENT symptoms in seven cases, asthenia in eight cases, conjunctivitis in 8, dyspnea in 5 cases, emesis in 5 cases, anosmia in four cases, upper respiratory tract infection in 4 cases, congestion in 4 cases, coryza in three cases, nausea in 3 cases, pain in 3 cases, ageusia in 2 cases, dysgeusia in 2 cases, chest pain in two cases, and maculopapular rash in 2 cases ( 6 , 11 – 15 , 17 – 22 , 24 , 28 , 30 – 34 , 36 – 38 , 40 , 42 , 43 , 47 , 50 – 52 , 54 , 57 ).…”

“…Warming measures were recommended in 74 cases ( 11 ). Fifty-seven unspecified treatments were also reported, and 59 cases did not receive treatment ( 11 , 19 , 24 , 25 , 51 , 57 ). A number of treatments were also reported without specified numbers: Supplementary Table S2 .…”