IMPORTANCE Chilblain-like lesions have been reported during the coronavirus 2019 (COVID-19) pandemic. The pathophysiology of such manifestations remains largely unknown. OBJECTIVE To perform a systematic clinical, histologic, and biologic assessment in a cohort of patients with chilblain-like lesions occurring during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS In this prospective case series carried out with a COVID-19 multidisciplinary consultation group at the University Hospital of Nice, France, 40 consecutive patients presenting with chilblain-like lesions were included. MAIN OUTCOMES AND MEASURES Patients underwent a thorough general and dermatologic examination, including skin biopsies, vascular investigations, biologic analyses, interferon-alpha (IFN-α) stimulation and detection, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) and serologic analysis. RESULTS Overall, 40 consecutive patients with chilblain-like lesions were included. Most patients were young, with a median (range) age of 22 (12-67) years; 19 were male and 21 were female. The clinical presentation was highly reproducible with chilblain-like lesions mostly on the toes. Bullous and necrotic evolution was observed in 11 patients. Acrocyanosis or cold toes were reported in 19 (47.5%) cases. Criteria compatible with COVID-19 cases were noted in 11 (27.5%) within 6 weeks prior to the eruption. The real-time PCR (rt-PCR) testing results were negative in all cases. Overall, SARS-CoV-2 serology results were positive in 12 patients (30%). D-dimer concentration levels were elevated in 24 (60.0%) cases. Cryoglobulinemia and parvovirus B19 serologic results were negative for all tested patients. The major histologic findings were features of lymphocytic inflammation and vascular damage with thickening of venule walls and pericyte hyperplasia. A significant increase of IFN-α production after in vitro stimulation was observed in the chilblain population compared with patients with mild-severe acute COVID-19. CONCLUSIONS AND RELEVANCE Taken together, our results suggest that chilblain-like lesions observed during the COVID-19 pandemic represent manifestations of a viral-induced type I interferonopathy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04344119

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The implementation of an antifungal stewardship programme was feasible, sustainable and well accepted. We observed an improved quality of care for some process of care measures, and antifungal use and cost were contained in our hospital.

Background Recent literature reports a strong thrombotic tendency in patients hospitalized for a Covid‐19 infection. This characteristic is quite unusual and seems specific to Covid‐19 infections, especially in their severe form. Viral infections can trigger acquired thrombophilia which can then lead to thrombotic complications. We investigate for the presence of acquired thrombophilia, which could participate in this phenomenon and report their prevalence. We also wonder if these thrombophilias participate in the bad prognosis of severe Covid‐19 infections. Methods and Results In 89 consecutive patients hospitalized for Covid‐19 infection we found a 20% prevalence of protein S deficiency and a very high ie.: 72% prevalence of antiphospholipid antibodies: mainly lupus anticoagulant. The presence of PS deficiency or antiphospholipid antibodies was not linked with a prolonged aPTT nor with D‐dimer, fibrinogen or C‐reactive protein concentrations. These coagulation abnormalities are also not linked with thrombotic clinical events occurring during hospitalization nor with mortality. Conclusions We assess a high prevalence of positive tests detecting thrombophilia in Covid‐19 infections. However, in our series, these acquired thrombophilias are not correlated with the severity of the disease nor with the occurrence of thrombotic events. Albeit the strong thrombotic tendency in Covid‐19 infections, the presence of frequent acquired thrombophilia may be part of the inflammation storm of Covid‐19 disease and should not systematically modify our strategy on prophylactic anticoagulant treatment which is already revised upwards in this pathology.

Combination therapy was the preferred treatment strategy for infections caused by carbapenem-resistant Gram-negative bacteria among hospital representatives, even though high-quality evidence for carbapenem-based combination therapy is lacking.