key: cord-0776745-umdqwuqd authors: Farouk, Shaimaa; Sadek, Ahmed title: Cutaneous Manifestations of Covid 19: A Case Report & a new finding from Egypt date: 2020-07-21 journal: Dermatol Ther DOI: 10.1111/dth.14038 sha: 2bfa9e72fc57becd25b133bc0bffb056137098be doc_id: 776745 cord_uid: umdqwuqd nan lesions in the form of oral congestion and petechiae, sore throat and pain was referred to the ear. She was home isolated and started symptomatic treatment. Three days later, she started to take Azithromycin 500 mg/day for 5 days and Oseltamivir 75mg/12 hours for 5 days, but unfortunately her condition worsened and CT chest showed ground glass opacities and she started Hydroxychloroquine PO (400mg /12 hours for 1 day then 200 mg/12 hours for 9 days), the skin lesions started to fade out while itching continued for several days, a unique finding was seen in the form of sudden eruption of 12 wart-like lesions on the lower extremities, of different clinical types (planter & plane) and sizes (0.2 -2 cm in diameter), which, to our knowledge, was not described before. Her general condition worsened over the next few days, she got hospitalized, rapid test for Covid19 was positive for IgM, and she was prescribed intravenous Methylprednisolone (1.5 mg/kg/d for 5 days), Anti-Coagulation therapy (Enoxaparine (1 mg/kg BID for 5 days) ), Levofloxacin (500mg /day for 5 days) After few days, she got better, nasaopharyngeal swabs for covid19 were negative and discharged from hospital on pulse prednisone 80 mg PO 2 days a week for 2 weeks with gradual tapering, and Rivaroxaban (10 mg/d for 4 weeks) after which her condition resolved with deterioration of her warts in a slowly progressive fashion. We believe that these skin lesions were part of the COVID-19 syndrome, as she had most of the clinical, laboratory and imaging features associated with the disease, with positive rapid IgM test. In an early study in China [4] , researchers found 2 cases with skin eruptions among the 1099 cases of covid19 (0.02%), others described acral eruptions as one of the early manifestations of cutaneous COVID-19 [5] , others described vesicular lesions [6] ,hemorrhagic eruptions [6] or varicella like eruptions [7] [3] To our knowledge, this is the first case to report wart-like lesions in association with COVID-19. This may be due to the presence of subclinical infection with Human Papilloma Virus (HPV) that was dormant in skin, as a sequelae to her profession, and exacerbated by lowered immunity due to SARS-COV2 viral infection, or suggestively, the SARS-COV2 may make the host more susceptible for other viral infections. This article is protected by copyright. All rights reserved. Accepted Article WHO Declares COVID-19 a Pandemic Guntinas-Lichius O: The COVID-19 pandemic and otolaryngology: What it comes down to? COVID-19 can present with a rash and be mistaken for dengue Clinical Characteristics of Coronavirus Disease 2019 in China Acral cutaneous lesions in the Time of COVID-19 Cutaneous manifestation of COVID-19 in images: A case report Varicella-like exanthem as a specific COVID-19-associated skin manifestation: Multicenter case series of 22 patients