Cutaneous Clinico-Pathological Findings in three COVID-19-Positive Patients Observed in the Metropolitan Area of Milan, Italy

Abstract

The novel coronavirus SARS-CoV-2/COVID-19 is rapidly and dramatically spreading throughout the world. We describe the clinical and histopathological features of 3 Italian patients with different cutaneous presentations of COVID-19 infection, observed and followed at the University of Milan. CASE REPORTSCase 1. A 59-year-old woman was admitted to the intensive care unit (ICU) at the University of Milan with bilateral interstitial pneumonia. Three days after admission, she developed widespread erythematous macules on arms, trunk and lower limbs (Fig. 1 A-C) that spontaneously improved within 5 days. C-reactive protein was 12 mg/l. Reverse transcriptase (RT)-PCR for COVID-19 virus was positive. Treatment was started with lopinavir-ritonavir, heparin and levofloxacin. She is currently recovering. Case 2. An 89-year-old woman was suffering from fever and cough of one-week duration. An exanthem on the trunk and arms was observed on admission at ICU (Fig. 1 D,E). Laboratory tests revealed mild increase in fibrinogen and transaminases. RT-PCR was positive for COVID-19 virus. Ceftriaxone and azithromycin were started. The exanthem improved spontaneously 8 days later. Case 3. A 57-year-old man in good general health acutely developed a widespread pruritic eruption of erythematous macules and papules (Fig. 1 F,G), followed two days later by fever, headache, cough and arthralgias. RT-PCR for COVID-19 virus was positive. Treatment with levofloxacin and hydroxychloroquine was started.

Oral vesicles and acral erythema: report of a cutaneous manifestation of COVID‐19

“…Varicelliform and vesicular eruptions have been previously documented in COVID‐19, involving the trunk and extremities 1 . Histologically, acantholysis, dyskeratosis, ballooning degeneration, and necrosis of the keratinocytes have been reported in the skin lesions of COVID‐19, which can mimic herpetic infection 5 . We report this case to raise awareness that, in the appropriate clinical scenario, oral vesicles, especially in children, could represent a cutaneous manifestation of evolving COVID‐19 disease.…”

“…An acro‐ischemic, pernio‐like eruption has been reported in asymptomatic or mildly affected children and adolescents 4 . Histopathologic evaluation of COVID‐19 skin lesions may show vascular microthrombi and lymphocytic vasculitis 5 …”

Cutaneous manifestations of the Coronavirus Disease 2019 ( COVID ‐19): A brief review

“…Skin lesions mainly appeared erythematous, urticarial, and vesicular (chicken pox-like or varicelliform). [1][2][3][4][5][6][7][8][9][10][11][12] Petechiae rash, 13 livedo reticularis, 14 and reactivation of oral herpes simplex virus type 1 (HSV-1) 2 were also observed in single cases. Newly reported eruptions like vascular lesions and peculiar (perniosis-like) skin lesions caused concern among dermatologists.…”

“…10,11 Among nine patients receiving treatments, 1,5-7,9-11 two presented with rash before 1,11 while six developed skin eruptions following drug administration. [5][6][7]10,11 4 | DISCUSSION Recently, Recalcati and colleagues reported the cutaneous manifestations of COVID-19 infection in Italy and asked for more papers to confirm and better understand the pattern of skin involvement with COVID-19. 3 As the disease became pandemic globally, additional evidence has been constantly emerging.…”

Cutaneous Manifestations of COVID-19: A Systematic Review

“…A few articles also described skin biopsy ndings, which almost uniformly revealed a perivascular mononuclear/lymphocytic in ltrate with occasional small vessel thrombosis. 8,15,16,19,22,26,32,36 One study in particular revealed a complement-mediated thrombogenic vasculopathy with deposition of C4d and C5b-9 on histopathology. 5 The association and time relationship between each dermatologic manifestation and the non-cutaneous symptoms of COVID-19 (like fever, cough, shortness of breath, malaise and myalgia) is depicted in Table 3.…”