key: cord-0815627-h3ve1od9
authors: Hahn, Barry; Langhan, Danielle; Miller, Daniel; Greenstein, Josh
title: Images in Emergency Medicine: Painful Foot Lesions in a COVID Patient
date: 2020-05-12
journal: Ann Emerg Med
DOI: 10.1016/j.annemergmed.2020.05.012
sha: 2f34df89977a1a59eb0957048a366fd550c723cd
doc_id: 815627
cord_uid: h3ve1od9

nan

A 40-year-old male with no past medical history presented to the emergency department with bilateral toe pain, which developed over 2-3 days. He was afebrile and denied associated complaints. Physical examination was significant for erythematous, tender regions over the toes of both feet (Image 1). The patient subsequently tested positive for coronavirus .

Diagnosis: COVID Toes (CT). There has been recent discussion regarding less common clinical manifestations of SARS-CoV-2, the virus that causes COVID-19. One such possible symptom has been labeled CT. Individuals report areas of red or purple discoloration on the feet or hands, sometimes accompanied by a burning sensation, pain or tenderness. Initial lesions are papular and may evolve over one week to become purpuric and flattened. 1 Affected patients are often in their second or third decade of life, but symptoms have also been reported in older adults. CT is unique because it tends to appear in asymptomatic or mildly affected patients. Most report spontaneous resolution within two weeks. The exact mechanism remains unclear. Suggested etiologies include local vasculitis or thrombotic events. One study found all COVID-19 patients in the intensive care unit to have acro-ischemia. 2 Similar manifestations have been found in other diseases. However, the incidence of CT has been higher than expected since the COVID-19 pandemic onset. Furthermore, a recent report found that 20% of COVID-19 patients had skin-related symptoms. 3 Although experts argue whether CT is a symptom of COVID-19, all agree that the medical community should be aware of CT as a possible symptom.

Chilblain like lesions on feet and hands during the COVID 19 Pandemic

Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia

Cutaneous manifestations in COVID 19: a first perspective

The Journal of the European Academy of Dermatology and Venereology

Image 1. Dorsal surface of the foot demonstrating circumscribed, tender, erythematous, solid elevations of the skin

Image 2. Ventral surface of the foot demonstrating circumscribed, tender, erythematous, solid elevations of the skin