SARS-CoV-2: It is Severe and Acute, but is it Only a Respiratory Syndrome?

Abstract

Case report. A 13-year-old boy suddenly presented poorly symptomatic foot lesions on March 8, 2020. The clinical features observed and documented by the pediatrician consisted of 5-15 mm in diameter, erythemato-violet, rounded lesions with blurred limits on the plantar surface of the 1st right toe (Fig. 1) and on the dorsal surface of the 2nd toe both on the right and left foot. The boy had not taken any drug because he had no symptoms on other organs. After 2 days he presented general phenomena -fever at 38.5 °C, muscle pain, headache and intense itching and burning on the foot lesions -. Meanwhile, an about 1 cm in diameter blister with a tense roof and serous content had formed on the lesion of the left 2nd toe (Fig. 2). A plastic surgeon was consulted who advanced the hypothesis of violin spider bites and prescribed an oral macrolide and topical therapy. After 7 days from the beginning, the lesions persisted assuming a purpuric aspect (Fig. 3) that worsened further in the following days (Fig. 4) with the formation of blackish crusts (Fig. 5). After a few days, the pain and the cutaneous lesions began to regress.Since in those days began to circulate in Italy on social networks and in particular in the pediatric dermatology forum "Amici DermPed" images of acrolocated ischemic lesions, especially in the feet of children with suspected COVID-19 we investigated the family history that highlighted how the patient's mother and sister had both presented fever, cough and dyspnea 6 days before the appearance of his foot lesions. The suspicion of COVID-19 was therefore also raised for the boy. Unfortunately, it has not yet been possible to confirm the suspicion of COVID-19 due to the emergency situation present at this time in Italy.