key: cord-0055477-lh0xjus8 authors: Cuenca Saez, M.A.; Gomez-Biezna, S.L. title: Immunoglobulin A Antiphospholipid Antibodies in Patients With Chilblain-like Lesions During the COVID-19 Pandemic() date: 2021-01-21 journal: Actas Dermosifiliogr DOI: 10.1016/j.adengl.2021.01.008 sha: f53850557427f1b167a0f4b8ffffd7ae36bf91bf doc_id: 55477 cord_uid: lh0xjus8 nan Carta científico-clínica Presencia de anticuerpos antifosfolípidos IgA en pacientes con lesiones pernióticas asociadas a COVID-19 Owing to the information provided in the media about a possible association between skin lesions and SARS-CoV-2, we received many patients with self-limiting purpuric acral lesions during the month of April 2020. 1 This situation paves the way for several lines of study, in which laboratory analysis can play an essential role and in which differences in the behavior of the virus in the body can be explained in many settings by cutaneous manifestations, both at diagnosis and during follow-up. We consider that, during the initial stage of the infection, the mucous membrane may play a key role with respect to immunoglobulin (Ig) A antibodies. We retrospectively reviewed the cases of 11 patients with chilblain-like lesions 2,3 seen at Hospital de Almansa, Albacete, Spain (Fig. 1) . Some of the patients had had clinical manifestations associated with SARS-CoV-2 infection up to 2 weeks before the onset of the skin lesions. Patients were aged 2 to 40 years. The lesions comprised acral erythematous purpuric macules and papules 4,5 accompanied by edema and occasionally progressing to blisters, vesicles, pseudopustules, and crusts (Fig. 2) . We requested the following analyses: complete blood count, liver enzymes, ferritin, antinuclear antibody, lupus anticoagulant, immunoglobulins, and anticardiolipin IgA, IgG, and IgM. 6, 7 We also analyzed anti-ß 2 -glycoprotein antibodies and complement C3 and C4 and ran a lateral-flow immunochromatographic assay (COVID-19 IgG/IgM Rapid Test Cassette, Zhenjiang Orient Gene Biotech Co., Ltd). The Cov2019 polymerase chain reaction (PCR) assay, which is based on nasopharyngeal swab specimens, was performed in 2 cases where the patients had active symptoms and yielded a positive result in 1. The IgM/IgG rapid test, which was performed in all cases, yielded positive results in only 3 patients, 1 of whom had active disease (PCR+), and 2 asymptomatic patients, who had had self-limiting infection for 2 weeks, after which time they presented with chilblains. Laboratory tests revealed reduced complement C3 in 5 patients. All 5 had increased IgA anticardiolipin antibody; while this increase was slightly high, it was not considered positive according to the reference parameters of the external laboratory. involving antibodies enables conclusions to be drawn with respect to the following: No grants were received from the public, commercial, or nonprofit sectors. The authors declare that they have no conflicts of interest. J o u r n a l P r e -p r o o f I am grateful to the Head of the Laboratory at Hospital General de Almansa for showing such a high degree of intrinsic motivation. I am also grateful to the patients and, more than ever, to health professionals for their unceasing willingness to fight the current pandemic. La presente no ha recibido ayudas específicas provenientes de agencias del sector público, sector comercial o entidades sin ánimo de lucro Los autores declaran no tener ningún conflicto de intereses Agradecimientos Al responsable de Laboratorio de mi Hospital, por esa gran motivación intrínseca que desprende, y a los pacientes y resto de profesionales sanitarios, que más que nunca en esta situación de Pandemia han demostrado sus ganas incesantes de luchar. Cutaneous manifestations in COVID-19: a first perspective Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia A new vasculitis at the time of COVID-19 Viral infections and antiphospho-lipid antibodies Characterization of acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak Coagulopathy and Antiphospholipid Antibodies in Pathients with Covid-19 Neutralizing antibody responses to SARS-CoV-2 in a COVID-19 recovered patient cohort and their implications Ministerio de Sanidad. Aprobado por la Ponencia de Alertas, Preparación y Respuesta con la colaboración de la SEIMC 1 9