COVID-19 Related Acro-Ischemic Neuropathic-like Painful Lesions in Pediatric Patients: A Case Seriese

Abstract

Background: A variety of skin manifestations have been associated with COVID-19 infection. Acral lesions on hands and feet, closely resembling chilblains, have been reported in association with COVID-19, which are nonspecific. These acro-ischemic painful lesions have been described mainly in asymptomatic and mildly symptomatic pediatric COVID-19 positive patients, without a precise pathogenetic mechanism.COVID-19-induced chilblains may portend an indolent course and a good outcome. In young patients, the IFN-1 response induces microangiopathic changes and produces a chilblain lupus erythematosus-like eruption with vasculitic neuropathic pain features. Objectives: This paper presented a case series of pediatric patients with COVID-19-related skin lesions and neuropathic-like pain. Methods: Clinical outcomes were collected from 11 patients diagnosed with painful erythematous skin lesions with neuropathic-like pain and positive IgG for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: It is a mildly symptomatic condition not related to severe pain rates, and it is treated with paracetamol due to the transitory nature of the problem, which provides good results. Conclusions: A particular point of interest is skin lesion manifestation as a further indirect sign of SARS-CoV-2 infection. Due to the initial manifestation of chilblains in pauci-symptomatic pediatric patients, they need to be immediately tested and isolated. Chilblains can be considered a clinical clue to suspect SARS-CoV-2 infection and help in early diagnosis, patient triage, and infection control.

A Pusher and a Clip Applied to Hind Paws Under Isoflurane Sedation to Evaluate Neuropathic Pain in a CCI Model

“…Although behavioral measures have been developed to evaluate pain in rodent models rated by responses of the paw to physical stimuli ( 2 , 3 ), researchers often struggle to get consistent and reliable reactions because of variable laboratory, experimenter, and animal conditions ( 5 ). In contrast, our results showed that under deep sedation, behavioral responses were nearly consistent between the three types of mechanical stimuli and constant force clips.…”

“…Neuropathic pain originates from pathophysiological defects of the peripheral or central nervous system ( 1 , 2 ). Several animal models were introduced to investigate the pathological and physiological mechanisms of neuropathic pain.…”

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“…Neuropathic pain is a problem that plagues many patients ( 7 ). Mirogabalin appears to offer a new effective and safe alternative for treatment in patients with DPNP and PHN and is currently approved in Japan.…”

“…Mirogabalin belongs to the class of drugs called gabapentinoids. Originally synthesized to treat refractory epilepsy, gabapentinoids are now considered first-line treatment for neuropathic pain (5)(6)(7). Mirogabalin is a potent, selective ligand of the α2δ-1 and α2δ-2 subunits of VGCCs.…”

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