SARS‐CoV‐2 infection presenting as a febrile rash

Amatore, F.; Macagno, Nicolas; Mailhe, Morgane; Demarez, B.; Gaudy‐Marqueste, C.; Grob, Jean‐Jacques; Raoult, Didier; Brouqui, Philippe; Richard, M.‐A.

doi:10.1111/jdv.16528

Cited by 70 publications

(91 citation statements)

References 9 publications

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“…In addition, there are reports of the erythema multiforme type 7 . A search of the PubMed database retrieved only seven case reports describing COVID‐19 patients with an erythema that included basic patient information such as sex, age and time course of rash; 8–14 these reports are summarized in Table 1. The mean patient age was 47.1 years, with a range of 6–67 years.…”

Section: Discussionmentioning

confidence: 99%

Three cases of COVID‐19 patients presenting with erythema

Tamai¹,

Maekawa²,

Goto³

et al. 2020

The Journal of Dermatology

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Individuals infected with the novel coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2 [SARS-CoV-2]) who develop coronavirus disease 2019 (COVID-19) experience many symptoms; however, cutaneous manifestations are relatively rare. The authors encountered three patients with COVID-19 who presented with erythema and suspected viral rash. In all cases, erythema appeared after the onset of the initial symptoms of COVID-19. Erythema was considered to be caused by COVID-19 and not a drug-induced eruption because, in all cases, erythema was relieved merely by external medicine and oral antihistamines, without discontinuing the original medication. The authors' hospital accepted 69 COVID-19 patients between 22 February 2020 and 31 May 2020 and, of these, three (4.3%) exhibited eruptions, and all cases presented erythema. Except for seven patients who exhibited positive nasopharyngeal swab tests for SARS-CoV-2 RNA but no symptoms, three (4.8%) of the remaining 62 patients exhibited erythema. Although various types of eruptions have been reported in patients with COVID-19, erythema was the only type in our patients. Erythema in the three patients exhibited many similarities to that previously reported in COVID-19 patients, particularly in the manner it appeared and disappeared. For these reasons, these three cases were considered typical examples of erythema in patients with COVID-19. Considering previous studies and the three cases reported here, there is a high probability that SARS-CoV-2 can cause erythema.

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Section: Discussionmentioning

confidence: 99%

Three cases of COVID‐19 patients presenting with erythema

Tamai¹,

Maekawa²,

Goto³

et al. 2020

The Journal of Dermatology

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“…Piccolo et al observed two different lesion patterns for acral lesions: erythematous-edematous types and blistering types. A few articles also described skin biopsy findings, which almost uniformly revealed a perivascular mononuclear/lymphocytic infiltrate with occasional small-vessel thrombosis [8,15,16,19,22,26,32,36]. One study in particular revealed a complement-mediated thrombogenic vasculopathy with deposition of C4d and C5b-9 on histopathology [5].…”

Section: Characteristics Of Cutaneous Symptomsmentioning

confidence: 99%

Cutaneous Manifestations of COVID-19: An Evidence-Based Review

2020

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Background The coronavirus disease 2019 (COVID-19) pandemic has affected 18 million people and killed over 690,000 patients. Although this virus primarily causes respiratory symptoms, an increasing number of cutaneous manifestations associated with this disease have been reported. Objective The aim of this review was to collate and categorize the dermatologic findings reported in patients with COVID-19 and identify specific lesions that may facilitate diagnosis and prognostication. Methods An evidence-based review of the PubMed database was conducted on 14 May, 2020 using the search terms "Covid-19 skin," "Covid-19 rash," "Covid-19 exanthem," and "Covid-19 chilblains." Peer-reviewed publications containing original COVID-19 patient cases and a discussion of the associated cutaneous findings were included in the analysis. Results The literature search identified 115 records, of which 34 publications describing 996 patients with dermatologic conditions were included. Case reports (n = 15), case series (n = 13), and observational prospective studies (n = 4) were the most common publication types. Acral lesions resembling pseudo-chilblains were the most frequent lesion identified (40.4% of cases), appearing in young adults (mean age, 23.2 years) after the onset of extracutaneous COVID-19 symptoms (55/100 patients). Erythematous maculopapular rashes affected 21.3% of patients, most frequently impacting middle-aged adults (mean age, 53.2 years) and occurring at the same time as non-cutaneous symptoms (110/187 patients). Vesicular rashes affected 13.0% of patients, appearing in middle-aged adults (mean age, 48.3 years) after the onset of other symptoms (52/84 patients). Urticarial rashes affected 10.9% of patients, appearing in adults (mean age, 38.3 years) and occurring at the same time as non-cutaneous symptoms (46/78 patients). Vascular rashes resembling livedo or purpura were uncommon (4% of cases), appearing in elderly patients (mean age, 77.5 years) and occurring at the same time as non-cutaneous COVID-19 symptoms (18/29 patients). Erythema multiforme-like eruptions, although infrequent (3.7% of cases), affected mostly children (mean age, 12.2 years). Conclusions Vesicular rashes may suggest an initial diagnosis of COVID-19, acral lesions may be most appropriate for epidemiological uses, and vascular rashes may be a useful prognostic marker for severe disease. As a potential correlate to disease severity, prognosis, or infectibility, it is critical that all healthcare professionals be well versed in these increasingly common cutaneous manifestations of COVID-19.

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“…Both the patients had mild symptoms and a favorable outcome. 21,22 Thereafter, an atypical digitate papulosquamous variant of PR has been reported by Sanchez et al, wherein the clinical findings were confirmed on histopathology. 23 A 6-month-old infant with classic Kawasaki's disease, having an erythematous blotchy rash, prominent tongue papilla, and cracked lips as her predominant mucocutaneous features, was surprisingly found to be COVID-19-positive through RT-PCR test.…”

Section: Dermatological Manifestations Of Covid-19mentioning

confidence: 86%

Dermatological Manifestations of COVID-19: A Brief Review

Kaur¹

2020

ANAMS

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The emphasis so far during the COVID-19 pandemic has been on the respiratory manifestations with little attention being paid to cutaneous manifestations. The novel coronavirus has a wide spectrum of cutaneous manifestations which are broadly divided into exanthematous and vasculopathic type of lesions. The effects of this novel virus on the integumentary system cannot be underestimated as it can mimic various types of viral skin lesions. Thus, dermatologists should have knowledge about COVID-19 disease presentations and which differential diagnosis to consider if they encounter skin lesions in a patient who is known or suspected to have COVID-19. Patient evaluation and workup also needs to be modified during the time of this pandemic. Immunosuppressive/immunomodulatory drugs which are rampantly used in dermatological practice, must be used only after weighing their risks and benefits during the COVID-19 era. Personal Protective Equipment has to be worn when coming in contact with a suspected or a proven case of COVID-19. However, its use itself is associated with dermatological side effects which should be known to dermatologist practising during the COVID-19 era. Teledermatology can go a long way in circumventing these issues and it should be made more accessible, especially in remote areas. Another future recommendation could be setting up of a national level organization or group for recording dermatological data related to COVID-19.

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SARS‐CoV‐2 infection presenting as a febrile rash

Cited by 70 publications

References 9 publications

Three cases of COVID‐19 patients presenting with erythema

Three cases of COVID‐19 patients presenting with erythema

Cutaneous Manifestations of COVID-19: An Evidence-Based Review

Dermatological Manifestations of COVID-19: A Brief Review

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