key: cord-0689382-itan7b3p
authors: Singh, Partik; Brickley, Sylvana; Mannava, Kathleen; Tausk, Francisco
title: Papular Purpuric Gloves and Socks Syndrome in a Patient with Previous COVID-19 Infection
date: 2021-08-25
journal: JAAD Case Rep
DOI: 10.1016/j.jdcr.2021.08.019
sha: ff6723585066a3e3f2905720166554b53d5ccab1
doc_id: 689382
cord_uid: itan7b3p

nan

Papular purpuric gloves and socks syndrome is a pruritic dermatosis that is typically 38 associated with Parvovirus B19 and other viral infections. 1 We present a case of a patient with 39 papular purpuric gloves and socks syndrome who was recently diagnosed with While numerous cutaneous manifestations of COVID-19 infection have been reported thus far, 2 41 to our knowledge, this dermatosis has not been reported. 42

A 62-year-old woman presented to the emergency department reporting several days of a 44 pruritic rash that started on the dorsal hands and then appeared on the dorsal feet. She was 45 afebrile with otherwise unremarkable vital signs and was discharged on triamcinolone 0.1% 46 cream twice daily. Two days later the rash had not improved, so she called her primary care 47 physician and was prescribed fluocinonide 0.05% ointment twice daily over the phone. The next 48 day, her pruritus improved, but her rash continued to spread to include her left thigh, which led 49 the patient to seek further evaluation by a dermatologist. 50

When the patient was evaluated for the first time in dermatology clinic, approximately 10 51 days after the rash first appeared, the rash had not resolved despite topical treatment. Further 52 interview revealed that she had tested positive for COVID-19 infection as demonstrated by 53 positive polymerase chain reaction 6 weeks before the rash appeared. She reported that she had 54 recovered from COVID-19 at home without need for supportive care. 55 On exam, she had unremarkable vital signs, Fitzpatrick V skin type, and violaceous 56 smooth papules coalescing into plaques on the dorsal hands, dorsal feet and to lesser extent on 57 the left anterior thigh. Petechial macules on the fingertips and shins were also noted. She did not 58 have involvement of mucosa, palms, or soles. A 3-millimeter punch biopsy obtained from a 59 representative lesion on the left dorsal hand demonstrated focal epidermal spongiosis, papillary 60 dermal edema with extravasated erythrocytes, and a lymphocytic perivascular infiltrate in the 61 superficial dermis. These histologic findings supported the diagnosis of papular purpuric glove 62 and socks syndrome. 63

Additional pertinent workup included Parvovirus B19 serologies positive for IgG, but 64 negative for IgM. Complete blood count with differential and comprehensive metabolic panel 65 were unremarkable. Since review of systems were not otherwise suggestive of another recent 66 viral illness, no further viral workup was ordered. She did, however, have negative serologies for 67 HIV and Hepatitis B/C two years prior to presentation. 68

The patient was continued on fluocinonide 0.05% ointment until her follow-up on April 69 30 th with marked improvement in the pruritic eruption. noting that despite an apparent confounder in Parvovirus serology, IgM tends to become positive 75 within a few days to weeks and remain so for only 6 months or so, while IgG may persist for life, 76 making a recent enough Parvovirus infection unlikely. 3,4 Moreover, the described exanthem has 77 been shown after a number of viral infections. 5 The histopathologic differential diagnosis may 78 also include entities such as Gianotti-Crosti, hand-foot-mouth disease, erythema multiforme, and 79 meningococcal sepsis, 6 though these are less consistent with the distribution and overall clinical 80 presentation of our patient's eruption. Understanding how COVID-19 may manifest on the skin 81 may help clinicians and patients more effectively recognize and manage its sequelae. 82 Papular purpuric gloves and socks syndrome is a pruritic dermatosis that is typically 157 associated with Parvovirus B19 and other viral infections. 1 We present a case of a patient with 158 papular purpuric gloves and socks syndrome who was recently diagnosed with COVID-19. 159

While numerous cutaneous manifestations of COVID-19 infection have been reported thus far, 2 160 to our knowledge, this dermatosis has not been reported. 161

A 62-year-old woman presented to the emergency department reporting several days of a 163 pruritic rash that started on the dorsal hands and then appeared on the dorsal feet. She was 164 afebrile with otherwise unremarkable vital signs and was discharged on triamcinolone 0.1% 165 cream twice daily. Two days later the rash had not improved, so she called her primary care 166 physician and was prescribed fluocinonide 0.05% ointment twice daily over the phone. The next 167 day, her pruritus improved, but her rash continued to spread to include her left thigh, which led 168 the patient to seek further evaluation by a dermatologist. context, these findings would support a diagnosis of papular purpuric gloves and socks 235 syndrome. 236

Papular-purpuric "gloves and socks" syndrome

The spectrum of 208 COVID-19-associated dermatologic manifestations: An international registry of 716 209 patients from 31 countries

Mandell, Douglas, and Bennett's Principles and 213 Practice of Infectious Diseases

Elk Grove Village, IL: American Academy 217 of Pediatrics

Papular-purpuric 'gloves and socks' syndrome: not only 219 parvovirus B19

Papular-purpuric gloves and socks syndrome