Concurrent chilblains and retinal vasculitis in a child with COVID‐19

Abstract

Dear Editor, Reports on COVID-19 in children are limited. Despite new data emerging, and understanding of the disease improves rapidly, there are as yet several features and complications related to the disease that remain unknown. Herein, we report the first case of a child with chilblains and retinal vasculitis related to COVID-19. An 11-year-old patient arrived at the Dermatology Emergency Department with a 2-week history of asymptomatic plaques on his toes. He did not complain of fever, respiratory symptoms (as cough or dyspnoea), headache, malaise, sore throat, nasal congestion or diarrhoea. He had no history of family exposure, and he was taking strict social distancing measures due to the Spanish Government restrictions applied on 13 March 2020. Physical examination showed oedematous and erythematous to violaceous plaques on the dorsal toes of both feet (Fig. 1). These lesions were clinically compatible with chilblains. A nasopharyngeal sample was obtained, and a reverse transcription polymerase chain reaction (RT-PCR) was negative for SARS-CoV-2. Serologic tests (both immunochromatographic and chemiluminescence immunoassay) showed negative SARS-CoV-2 IgM with positive IgG antibodies. Complementary studies, including Author contributions Drs Quintana-Castanedo Feito-Rodr ıguez and Mayor-Ibarguren conceptualized and designed the study, coordinated and drafted the initial manuscript, and reviewed and revised the manuscript. Drs Fern andez-Alcalde, Granados-Fern andez, Montero-Vega and de Lucas-Laguna designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

COVID-19 ocular findings in paediatric population

“…Nevertheless, some viruses such as Dengue and Chikungunya are known to cause retinal vasculitis, usually after acute infection, as shown in our patient (Lee et al 2017). Retinal vasculitis has also been reported in KD (12), but our patient didn´t develop any other manifestation of PIMS, as none of the patients with PIMS in our study had retinal vasculitis.…”

“…29% of patients presented red eye and they were diagnosed by slit lamp examination of: mild acute bilateral conjunctivitis (3 patients) and unilateral episcleritis (2 patients) ( Figure.1). Ocular fundus exam was normal in all patients, but in one of them, with unilateral retinal vasculitis, perivascular in ltrates and retinal exudates (Case 1) (12). OCT exam showed preserved macular and optic nerve head architecture in all patients, without any in ammatory signs.…”

In vivo demonstration of microvascular thrombosis in severe COVID-19

“…Quintana-Castenedo et al [12] reported retinal vasculitis with perivascular infiltrate and retinal exudates in ocular fundus examination of a child with COVID-19, they did not describe vascular obstruction in the retinal vessels. Besides the clinical presentation in children is milder, we considered that sublingual evaluation provides a more 13 (100) Tidal volume (ml), mean ± sd 374 ± 66 PEEP (cm of water), mean ± sd 12 ± 3 Plateau pressure (cm of water), mean ± sd 24 ± 4 Static compliance (ml/cm of water), mean ± sd 33 ± 8 Respiratory rate (cycles/min), mean ± sd 24 ± 4 FiO2 (%), range (min-max) 0.55-1.00 Drugs Norepinephrine, n (%) 6 (46) Midazolam, n (%) 13 (100) Fentanyl, n (%) 13 (100) Neuromuscular blocking agent, n (%) 13 (100) Hydroxychloroquine, n (%) 3 (23) Macrolide antibiotic, n (%) 13 (100) Corticosteroids, n (%) 9 (69) Antiplatelet agents, n (%) 0 (00) Therapeutic LMWH, n (%) 6 (46) Prophylactic LMWH, n (%) 7 detailed assessment of microcirculation than funduscopic examination.…”

“…Quintana-Castenedo et al [ 12 ] reported retinal vasculitis with perivascular infiltrate and retinal exudates in ocular fundus examination of a child with COVID-19, they did not describe vascular obstruction in the retinal vessels. Besides the clinical presentation in children is milder, we considered that sublingual evaluation provides a more detailed assessment of microcirculation than funduscopic examination.…”

COVID-19-associated vasculitis and vasculopathy

“…The highly sulfated state results in a negative density and binding capacity for a variety of positively charged ligands. A partial but representative summary of individual sites of vasculitis is provided (Table 1) [ [54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69].…”