key: cord-0783690-8g7yfkgq
authors: Parhar, Gaurav; Kalaji, Wael; Sargi, Jad; Adarkwah, Obed; Zaman, Kiran; Gerolemou, Louis
title: A CASE OF ERYTHEMATOUS AND VESICULAR RASH IN A CRITICALLY ILL PATIENT ADMITTED WITH SARS-COV2: VIRAL OR MULTI-DRUG EFFECT?
date: 2020-10-31
journal: Chest
DOI: 10.1016/j.chest.2020.08.675
sha: e1a547855d7a09ccb9e72a39b9883cf76223a1c6
doc_id: 783690
cord_uid: 8g7yfkgq

nan

CASE PRESENTATION: 36 YO female with PMH of Diabetes and HLD who presented with complaints of worsening malaise, myalgia and fever. SARS-CoV-2 real-time polymerase chain reaction confirmed the diagnosis of COVID-19. She was noted to have diffuse erythematous and vesicular rash over her trunk, upper extremities and groin. Her clinical picture quickly deteriorated and she was transferred to the ICU for acute hypoxemic respiratory failure requiring intubation and mechanical ventilation due to COVID-19 pneumonia. During her hospital course, her rash continued to worsen and evolve. Notably, she was exposed to a variety of medications including sulfa drugs. Upon dermatology evaluation, skin punch biopsy revealed perivascular dermatitis consistent with viral exanthem versus drug reaction. Patient's rash was treated with topical triamcinolone with improvement within a week. She remains acutely ill in the ICU being managed supportively.

DISCUSSION: Multiple studies have reported skin rashes thought to be related to SARS COV2 virus infection including rash on hands or feet that resembles chilblains ("COVID toes"), blisters, hives, maculopapular rash, papulosquamous, petechial or livedo (1,2). These rashes are very non-specific and may resemble other illnesses. A careful history with specific attention to onset, duration and progression of the rash may guide us to the likely etiology. Viral exanthem has been rarely associated with COVID-19. Non-specific rash has been reported in 0.2-1.2% in a cohort of confirmed COVID-19 (3). Our patient's rash was present on admission and it was noted from her medical record that she was on sulfa drugs and other antibiotics without adverse effects in the past, making a drug reaction less likely. The significance of these rashes is still unclear and so is their association with disease severity. Additional studies are warranted to determine specific host or pathogen-related factors that contribute to the development of such rashes, especially with the presence of concurrent COVID-19.

CONCLUSIONS: Our case underlines the importance of maintaining a high index of awareness for the occurrence and impact of the recognition of COVID19-related dermatological manifestations and its implications on the clinical course of critically ill patients.

Cutaneous manifestations of the Coronavirus Disease 2019 (COVID-19): A brief review

Petechial Skin Rash Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection

Clinical characteristics of coronavirus disease 2019 in China