Histological pattern in COVID‐19‐induced viral rash

Zengarini, Corrado; Orioni, Gionathan; Cascavilla, Alessandra; Solera, Clara Horna; Fulgaro, Ciro; Misciali, Cosimo; Patrizi, Annalisa; Gaspari, Valeria

doi:10.1111/jdv.16569

Cited by 46 publications

(59 citation statements)

References 8 publications

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“…Our rst patient showed similarities with a case of purpuric rash reported by Gianotti R et al 1 Common histological features were lymphocytic in ltration around the swollen blood vessels with extravasated erythrocytes and spongiosis. 1 Dilated vessels were also found by Zengarini C et al 3 in an erythematous rash associated with COVID-19. 3 In addition to ectasic vessels, our Case 1 showed endothelial swelling.…”

Section: Discussionmentioning

confidence: 60%

“…1 Dilated vessels were also found by Zengarini C et al 3 in an erythematous rash associated with COVID-19. 3 In addition to ectasic vessels, our Case 1 showed endothelial swelling.…”

Section: Discussionmentioning

confidence: 60%

“…However, very few studies on clinical-histopathological correlations of skin disorders associated with COVID-19 have been conducted. [1][2][3][4][5] Different clinical features of cutaneous involvement in patients affected with SARS-CoV-2 infection seem to reveal a full spectrum of viral interaction with the skin. 1 Herein, we report two COVID-19 patients developing a purpuric maculopapular rash and a sub-erythroderma, respectively.…”

Section: Introductionmentioning

confidence: 99%

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From SARS-CoV-2 hematogenous spreading to endothelial dysfunction: clinical-histopathological study of cutaneous signs of COVID-19

Patrì

Vargas

Buonanno

et al. 2020

Preprint

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Background: To date, very few studies on clinical-histopathological correlations of cutaneous disorders associated with COVID-19 have been conducted. Case presentation: The Case 1 was a 90-year-old man, who tested positive for SARS-CoV-2 from a nasopharyngeal swab. Two days later, he was hospitalized and after eleven days transferred to Intensive Care Unit. A chest CT showed bilateral ground-glass opacities. Just that day, an erythematous maculo-papular rash appeared on trunk, shoulders and neck, becoming purpuric after few days. Histological evaluations revealed a chronic superficial dermatitis with purpuric aspects. The superficial and papillary dermis appeared edematous, with a perivascular lympho-granulocytic infiltrate and erythrocytic extravasation. At intraepithelial level, spongiosis and a granulocyte infiltrate were detected. Arterioles, capillaries and post-capillary venules showed endothelial swelling and appeared ectasic. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Regrettably, due to severe lung impairment, he died.The Case 2 was a 85-year-old man, admitted to Intensive Care Unit, where he was intubated. He had tested positive for SARS-CoV-2 from a nasopharyngeal swab two days before. A chest RX showed bilateral atypical pneumonia. After seven days, a cutaneous reddening involving trunk, upper limbs, neck and face developed, configuring a sub-erythroderma. Histological evaluations displayed edema in the papillary and superficial reticular dermis, and a perivascular lymphocytic infiltrate in the superficial dermis. The patient was treated with hydroxychloroquine, azithromycin, lopinavir-ritonavir and tocilizumab. Sub-erythroderma as well as respiratory symptoms gradually improved until healing. Conclusions: The endothelial swelling detected in the Case 1 could be a morphological expression of SARS-CoV-2-induced endothelial dysfunction. We hypothesize that cutaneous damage could be initiated by endothelial dysfunction, caused by SARS-CoV-2 infection of endothelial cells or induced by immune system activation. The disruption of endothelial integrity could enhance microvascular permeability, extravasation of inflammatory cells and cytokines, with cutaneous injury. The Case 2 developed a sub-erythroderma associated with COVID-19, and a non-specific chronic dermatitis was detected at histological level. We speculate that a purpuric rash could represent the cutaneous sign of a more severe coagulopathy, as highlighted histologically by vascular abnormalities, while a sub-erythroderma could be expression of viral hematogenous spreading, inducing a non-specific chronic dermatitis.

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Section: Discussionmentioning

confidence: 60%

“…1 Dilated vessels were also found by Zengarini C et al 3 in an erythematous rash associated with COVID-19. 3 In addition to ectasic vessels, our Case 1 showed endothelial swelling.…”

Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

From SARS-CoV-2 hematogenous spreading to endothelial dysfunction: clinical-histopathological study of cutaneous signs of COVID-19

Patrì

Vargas

Buonanno

et al. 2020

Preprint

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“…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.…”

Section: Id Studymentioning

confidence: 99%

“…In December 2019, a new infectious pathogen named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identi ed in Wuhan, China. 1 Transmitted through respiratory droplets, SARS-CoV-2, commonly referred to as coronavirus disease 2019 (COVID- 19), has rapidly spread across the globe to infect 188 countries. The combination of its high infectivity and lengthy asymptomatic latency period has culminated in a global pandemic affecting 4.5 million people and resulting in over 300,000 deaths to date.…”

Section: Introductionmentioning

confidence: 99%

Cutaneous Manifestations of COVID-19: A Systematic Review

Daneshgaran

Dubin

Gould

2020

Preprint

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Background: The COVID-19 pandemic has affected 4.5 million people and killed over 300,000 patients. Although this virus primarily causes respiratory symptoms, an increasing number of cutaneous manifestations associated with this disease have been reported.Objective: The aim of this review was to collate and categorize the dermatologic findings reported in COVID-19 patients and identify specific lesions that may facilitate diagnosis and prognostication.Methods: A systematic review of the PubMed database was conducted on May 14th, 2020 using the search terms “Covid-19 skin,” “Covid-19 rash,” “Covid-19 exanthem,” and “Covid-19 chilblains.” Peer-reviewed publications containing original COVID-19 patient cases and a discussion of the associated cutaneous findings were included in the analysis.Results: The literature search identified 115 records, of which 34 publications describing 996 dermatologic patients were included. Case reports (n=15), case series (n=10) and observational studies (n=7) were the most common publication types. Pseudo-chilblains (PC) was the most frequent lesion identified (40.4% of cases), appearing in young adults (mean age, MA, 23.2 years) after the onset of extracutaneous COVID-19 symptoms (55/100 patients). Erythematous maculopapular rashes (EMR) affected 21.3% of patients, most frequently impacting middle-aged adults (MA 53.2 years) and occurring at the same time as non-cutaneous symptoms (110/187 patients). Vesicular rashes (VR) affected 13.0% of patients, appearing in middle-aged adults (MA 48.3 years) after the onset of other symptoms (52/84 patients). Urticarial rashes (UR) affected 10.9% of patients, appearing in adults (MA 38.3 years) and occurring at the same time as non-cutaneous symptoms (46/78 patients). Vascular rashes resembling livedo/purpura/necrosis (LPN) were uncommon (4% of cases), appearing in elderly patients (MA 77.5 years) and occurring at the same time as non-cutaneous COVID-19 symptoms (18/29 patients). Erythema multiforme-like eruptions (EME), although infrequent (3.7% of cases), affected mostly children (MA 12.2 years).Conclusions: VR may suggest an initial diagnosis of COVID-19, PC may be most appropriate for epidemiological uses, and LPN may be a useful prognostic marker for severe disease. As a potential correlate to disease severity, prognosis, or infectibility, it is critical that all health care professionals be well-versed in these increasingly common cutaneous manifestations of COVID-19.

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Dermatological manifestations associated with COVID‐19: A comprehensive review of the current knowledge

Afshar

Babazadeh

Hasanpour

et al. 2021

Journal of Medical Virology

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Coronavirus disease 2019 (COVID‐19) caused by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) has become a significant health problem globally. The virus has spread widely and become a global pandemic. The pathophysiology for SARS‐CoV‐2 has not been explained clearly. It has been associated with several multiorgan symptoms, among which its dermatological manifestations are of great interest. Primarily, there has been no report of skin features among COVID‐19 patients. Nevertheless, recently there have been several reports regarding COVID‐19 patients who presented with cutaneous manifestations. In the current review, we focus on the various cutaneous manifestations of COVID‐19 infection.

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Histological pattern in COVID‐19‐induced viral rash

Cited by 46 publications

References 8 publications

From SARS-CoV-2 hematogenous spreading to endothelial dysfunction: clinical-histopathological study of cutaneous signs of COVID-19

From SARS-CoV-2 hematogenous spreading to endothelial dysfunction: clinical-histopathological study of cutaneous signs of COVID-19

Cutaneous Manifestations of COVID-19: A Systematic Review

Dermatological manifestations associated with COVID‐19: A comprehensive review of the current knowledge

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