Leucocytoclastic vasculitis in a patient with COVID-19 with positive SARS-CoV-2 PCR in skin biopsy

Abstract

Main skin manifestations of COVID-19 have been recently classified. However, little is known about cutaneous histopathological patterns and the presence of SARS-CoV-2 in these skin lesions. We present a healthy 29-year-old man who developed a leucocytoclastic vasculitis for COVID-19 with positive SARS-CoV-2 PCR in skin biopsy.

Rheumatological complications of Covid 19

“…There are case reports documenting the presence of COVID-19 with cutaneous vasculitis - severe respiratory failure with ARDS developed in a patient with lower limb vasculitic purpura [ 103 , 104 ], a bullous haemorrhagic rash that progressed to necrotic lesions with histopathology confirmed vasculitis of small- and medium-sized cutaneous vessels [ 105 ], purple palpable papules and haemorrhagic blisters characterised histologically as leucocytoclastic vasculitis [ 106 ], and cutaneous vasculitic lesions and gangrene [ 107 ]. Camprodon Gómez et al [ 108 ] and Mayor-Ibarguren [ 105 ] both described patients with leucocytoclastic vasculitis with positive SARS-CoV-2 PCR in skin biopsies with positive serum IgM and IgG against SARS-CoV-2 but negative oropharyngeal swab PCR. This could indicate that leucocytoclastic vasculitis develops as a late manifestation of COVID-19 infection.…”

Leucocytoclastic vasculitis secondary to COVID-19 infection in a young child

“…Interestingly, the authors described the presence of SARS-CoV-2 PCR from a skin biopsy. 9 One of the limitations of our report is that we could not get the antibody titres for COVID-19 at the time of presentation of rashes in our index child. Though symptoms in our index child started a few weeks after the child was diagnosed positive for COVID-19, it could still be mere a chance that it was triggered by this virus as there are many other causes of the leucocytoclastic vasculitis.…”

“…There have been case reports of adults presenting with this entity after COVID-19 but none reported in a paediatric age group. [7][8][9] This might be mostly due to the relative low incidence rate of COVID-19 infection in children. However, asymptomatic infections in children still may cause silent vascular damage to them.…”

“…The biopsy had shown leucocytoclastic vasculitis. 8 Camprodon Gómez et al 9 reported a relatively younger 29-year-old man who presented with purple palpable papules over the lower limbs and abdomen. He had symptomatic COVID-19 infection a month prior to presentation.…”

COVID-19–related skin manifestations: Update on therapy

“… 30 , 56 , 57 More severe erythema multiforme-like eruptions can be treated with systemic steroids, 58 , 59 as well as leucocytoclastic vasculitis associated with COVID-19. A dose of 0.5 mg/Kg/daily has been reported as efficacious, 60 , 61 although a patient already under steroids developed a purpuric leukocytoclastic vasculitis. 62 Further isolated anecdotal case reports were not included in this review.…”