Bullae autoimmune diseases can be induced by environmental factors in a genetically susceptible individual, and viruses may be important triggers for this process. Coronavirus disease 2019 (COVID-19) is a multisystemic disease known for developing many types of skin lesions. However, little is known about post-COVID-19 manifestations. A previous healthy male patient, 43 years old, with resistant mediastinal Hodgkin's lymphoma stage II diagnosed in 2019, without treatment at the moment, developed monomorphic flaccid bullae on the trunk 40 days after testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although he had risk factors for IgA and paraneoplastic pemphigus, there were no elements for these diseases. The investigation confirmed a pemphigus vulgaris (PV). PV had a good response to treatment with prednisolone 1 mg/kg per day, and methotrexate 15 mg subcutaneously was added per week. The patient was discharged with oral methotrexate and prednisolone at the same dose. Prednisolone was decreased by 20 mg per day during the follow-up. Viruses such as herpesvirus, cytomegalovirus, and varicela zoster can act as triggers for PV. This process is not immediate after the infection because it depends on the change in antibodies initially produced against the virus that start to identify antigens present in the skin's anchoring structures. SARS-CoV-2 can induce autoimmunity, as seen in Guillán-Barré syndrome and in Kawasaki disease. It is a highly immunogenic virus that is the perfect agent for triggering PV. This case can be considered a cutaneous autoimmune post-COVID-19 manifestation.
Introdução: Durante a pandemia da COVID-19 foram adotadas medidas de isolamento social, para reduzir o contágio pelo novo coronavírus. Essas determinações dificultaram o acesso a cuidados médicos, exercícios e terapias, necessários para pessoas com Doença de Parkinson (DP). Objetivos: Esse trabalho busca entender como a pandemia e o isolamento social podem influenciar a sintomatologia da DP e as dificuldades enfrentadas pelos pacientes. Métodos: Pessoas com DP cadastradas no Programa Pró-Parkinson da Universidade Federal de Pernambuco foram convidadas por telefone para o telemonitoramento. Foram realizadas entrevistas, de 01/07/2020 a 25/08/2020. Na avaliação das barreiras na realização de atividades de vida diária foi aplicado MDS-UPDRS parte II: Aspectos Motores de Experiências da Vida Diária (M-EVD). Resultados: Foram acompanhadas 31 pacientes, com idade média de 67 anos. 64,5% dos indivíduos relataram piora dos sintomas, entre esses 40% apresentaram dificuldades de adesão ao tratamento farmacológico. Foi constatado que 90,3% apresentaram, como uma barreira importante, o acesso à fisioterapia durante a pandemia. Piora da marcha (67,7%), ou fala (61,3%) e dificuldade na execução de tarefas cotidianas foram as atividades de maior desconforto durante isolamento. Conclusão: Através do telemonitoramento observou-se que a pandemia da Covid-19 afetou significativamente a sintomatologia e o manejo clínico das pessoas com DP, ao distanciá-las dos serviços médicos e terapêuticos. Além disso, estresse e ansiedade durante o isolamento possivelmente contribuíram para a piora dos sintomas motores e não motores da doença. O telemonitoramento teve importante contribuição para o acompanhamento durante o isolamento.
We report four cases of children who presented skin lesions compatible with viral etiology after close contact with adults with coronavirus disease. Children presented a light exanthematous rash, a mild Pityriasis rosea, erythematous-edematous plaques on the legs with facial rash or papules and umbilicated vesicles on the scrotum without other symptoms.
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