key: cord-0684305-9gt30fkc
authors: Mahé, A.; Birckel, E.; Krieger, S.; Merklen, C.; Bottlaender, L.
title: A distinctive skin rash associated with Coronavirus Disease 2019 ?
date: 2020-04-15
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.16471
sha: d8a1259bc30944c8def1fa114596b06bd3fb659d
doc_id: 684305
cord_uid: 9gt30fkc

A skin rash has been reported in 2 out of 1.099 patients presenting with Coronavirus disease 2019 in China [1], as in 14 of 48 patients with the same disease in Italia, but unfortunately without further description of its semiology [2]. We wish to report here the case of a woman who presented, coincidently with Covid‐19, a skin rash that had an original picture.

This article is protected by copyright. All rights reserved DR. ANTOINE MAHE (Orcid ID : 0000-0003-1228-2220) Article type : Letter to Editor A distinctive skin rash associated with Coronavirus Disease 2019 ?

A skin rash has been reported in 2 out of 1.099 patients presenting with Coronavirus disease 2019 in China [1] , as in 14 of 48 patients with the same disease in Italia, but unfortunately without further description of its semiology [2] . We wish to report here the case of a woman who presented, coincidently with Covid-19, a skin rash that had an original picture.

A 64 years old woman with type 2 diabetes presented with fever (up to 40° C) and asthenia, for which she began to take oral paracetamol. Four days later, an erythematous rash began on both antecubital fossa ( Fig. 1) , that extended during the following days on the trunk and axillary folds (Fig 2) ; fever persisted, and a cough appeared. A chest CT showed bilateral interstitial abnormalities. A RT-PCR test on a nasopharyngeal swab specimen was positive for SARS-CoV-2 ARN. There was no suspicion of systemically applied contact allergen. The rash disappeared five days after its beginning (at day 9 of the disease), while fever persisted until day 16, a period during which the patient repeatedly took paracetamol. All symptoms finally resolved at day 18.

The rash described here appeared to us reminiscent of Symmetrical Drug-Related Intertriginous and Flexural Exanthema (SDRIFE), a condition that has been regularly reported in association with the intake of certain drugs, but also more rarely in association with a viral infection, such as primary parvovirus B19 infection [3, 4] . The role of paracetamol could also be discussed here but, in addition to the fact that paracetamol has been only exceptionally reported as a cause of SDRIFE [5] , the rash disappeared despite the continuation of the drug, an unusual occurrence in drug reactions.

In conclusion, we wish to draw the attention of clinicians on a skin rash with a subtle but rather distinctive picture that, although skin symptoms seem unusual during Covid-19, may have a diagnostic utility if other similar observations happen to be reported. 

Clinical characteristics of coronavirus disease 19 in China

Cutaneous manifestations in COVID-19: a first perspective

Exanthème à type de "syndrome babouin" au cours d'une primo-infection par le parvovirus b19 : deux cas

Human parvovirus B19 infection showing follicular purpuric papules with a baboo syndrome-like distribution

Pracetamol-induced symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) in a psoriasis patient receiving apremilast therapy

This article is protected by copyright. All rights reserved Hôpital Pasteur, Colmar, France antoine.mahe@ch-colmar.fr