COVID-19 is an ongoing multisystemic viral infection, which affects both adults and children. The virus has a complicated and not fully understood pathophysiological mechanism of damaging different organs and systems, including the skin. Cutaneous manifestations classification is complicated by the great variety of lesions and histological appearances, neither specific. Herein, a thorough overview of the clinical and pathological peculiarities of skin changes observed in the acute and re-convalescent stages of COVID-19 infection, is highlighted. The pathophysiological mechanisms, suggested to trigger and sustain the dermatological dysfunction, are also considered in the vicinity of authors’ personal experience.
A 42‐year‐old man presented with an 18‐month history of right earlobe indolent rigid swelling. The patient was in good health, had taken no medication recently, and did not have allergies. The physical examination showed rigid, red‐bluish infiltrate of the right earlobe. No plicated tongue was present. The routine blood tests (blood cell counts, blood glucose, liver enzymes, electrolytes, serum angiotensin‐converting enzyme level, and chlamydial and gonococcal serological tests) were within normal ranges. Parasitological feces tests and a gastrointestinal occult bleeding analysis were negative. Lung x‐ray examination, fibrocolonoscopy, and abdominal ultrasonography did not show any pathologic findings. Mantoux test was normergic. Electromyogram of facial muscles and facial nerve were normal. Otorhinolaryngologic examination gave no data of focal infections. A vertical segmental biopsy of the right earlobe infiltrate showed histologic data of noncaseating Langerhans cell granulomas () with epithelioid cells and central lymphocytic infiltrate (). Microscopic foci of necrosis were not found. No acid‐fast bacteria were demonstrated by Ziehl‐Neelsen staining method. Culture and animal inoculation to rule out Mycobacterium bovinum were not undertaken. A course of systemic, non‐steroidal, anti‐inflammatory drugs did not prove effective. This was followed by intralesional corticosteroid treatment that resolved the inflammation and stopped lesion progression.
1
Noncaseating Langerhans cell granulomas
2
Langerhans cells
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