key: cord-0815929-162uk7wm
authors: Klimach, Anna; Evans, Jordan; Stevens, Jennifer; Creasey, Nikola
title: Rash as a presenting complaint in a child with COVID‐19
date: 2020-06-11
journal: Pediatr Dermatol
DOI: 10.1111/pde.14257
sha: e65dbcd8912b95f17b4892b428cc797068f72ac1
doc_id: 815929
cord_uid: 162uk7wm

Cutaneous manifestations are becoming increasingly well‐documented in adults with COVID‐19. There is now also a growing body of literature regarding skin involvement in children, with reports of papulovesicular, petechial and widespread macular and papular lesions, as well as chilblains (pernio). We describe the case of a thirteen‐year‐old boy with confirmed COVID‐19 in the United Kingdom who presented with skin findings localized to the plantar aspects of the feet, axillae and lower limbs. The morphology was predominantly maculopapular but also included petechiae and annular lesions.

Diagnosis of COVID-19 in children is currently uncommon compared to adults. Children who are symptomatic most commonly display cough, fever, pharyngeal erythema and gastrointestinal symptoms. 1 In children, cutaneous manifestations include widespread erythematous macular and papular lesions, a skin rash in the context of a multisystem inflammatory state or similar clinical presentation to Kawasaki's disease, and papulovesicular eruptions. 2, 3 We report a case of confirmed COVID-19 in a child who presented with skin findings localized to the axillae, lower limbs and plantar aspects of the feet.

A thirteen-year-old boy presented in April 2020 with the chief complaint of pain in the soles of his feet. He also had a 24-hour history of fever, myalgia and headache. He denied any

This article is protected by copyright. All rights reserved respiratory symptoms. He had taken acetaminophen infrequently. He was previously fit and well with no comorbidities. His stepfather reported a flu-like illness and his mother a mild cough.

On examination, he was systemically well with normal vital signs. There was an erythematous papular eruption in the axillae with axillary and cervical lymphadenopathy, all nodes measuring < 1cm. On the plantar surface of his feet were multiple tender, erythematous papules each measuring approximately 1 cm (Figure 1 ). There were no vesicles or pustules. Erythematous macules with associated scattered petechiae, located in close proximity to the macules, were also present on the child's distal lower extremities The clinical photographs provided were taken by the family two days after presentation, at which point annular lesions were evident on the distal lower extremities. He continued to have intermittent mild flu-like symptoms for five days but did not develop any cough or dyspnea. The skin changes fully resolved within 10-14 days.

Currently the most commonly reported symptoms of COVID-19 in the pediatric population are cough and fever. 1 The adult literature describes erythematous rashes, chilblains,

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COVID-19 can present with a rash and be mistaken for dengue": petechial rash in a patient with COVID-19 infection

This article is protected by copyright. All rights reserved urticaria, vesicular lesions, petechiae, purpura and papules. 4 There is also reference to localization to the axillae and soles of the feet. 5 A common theme in the adult data is the hypothesis that the skin findings are secondary to a drug reaction in view of the use of experimental treatments such as hydroxychloroquine and lopinavir. 5 

This article is protected by copyright. All rights reserved 

This article is protected by copyright. All rights reserved