key: cord-0837453-ehav9bv0
authors: Diotallevi, Federico; Campanati, Anna; Bianchelli, Tommaso; Bobyr, Ivan; Luchetti, Michele Maria; Marconi, Barbara; Martina, Emanuela; Radi, Giulia; Offidani, Annamaria
title: Skin involvement in SARS‐CoV‐2 infection: Case series
date: 2020-06-02
journal: J Med Virol
DOI: 10.1002/jmv.26012
sha: 643a0f1da7bab1c42f648df63f53a88653c44c00
doc_id: 837453
cord_uid: ehav9bv0

since the beginning of the well-known SARS CoV-2 pandemic, skin involvement both in adults and children has been signaled (1,2). However, large-scale studies describing skin manifestations and their etiopathogenic correlation with COVID-19 in detail have not been reported yet. Through the analysis of emerging data from literature (3) and the direct observation of three patients with COVID-19 (SARS-CoV-2 detection from nasopharyngeal swab samples through RNA extraction) and dermatological manifestations, we have hypothesized different mechanisms for their development. This article is protected by copyright. All rights reserved.

following days urticaria improved gradually ( Figure 1 ). Twenty-five days after entering into hospital, the patient was discharged for resolution of pneumonia and negative extraction of SARS-CoV-2 RNA from her nasopharyngeal swab in two consecutive times. CASE 2: Dermatological consultation was requested from anesthesiology division because of the appearance of an urticarial rash in a 64-year-old patient with acute respiratory distress syndrome (PaO 2 /FiO 2 ≤ 100 mm Hg) caused by COVID-19 ( Figure 2 ). Skin rash was already present at the time of hospital admission. As in previous clinical case, neither history of allergy to drugs or foods, nor recent intake of new drugs were reported into patient's medical record.

Patient was, at that moment, in treatment with lopinavir/ritonavir and hydroxychloroquine from 1 week, and no new drug introduction had been made in the last 3 weeks before skin rash development.

Blood test revealed abnormal blood count with neutrophil leukocytosis (neutrophil granulocytes 8.600/mm 3 ), and mild lymphopenia (lymphocites 700/mm 3 ), moderate increase of procalcitonin serum levels (0.87 ng/mL), marked increase of CRP (10.2 mg/dL), and liver enzymes (GOT, GPT, LDH, GGT fourfold levels) serum levels. Patient was receiving mechanical ventilation for respiratory failure.

As in previous case, diagnosis of urticarial skin rash was made, and treatment with intravenous administration of methylprednisolone 40 mg/die and bilastine 20 mg/die was started. Currently, patient is still hospitalized in Anesthesiology Department, in stable clinical conditions, skin rash is slightly improved after 48 hours from the beginning of the treatment. Figure 3A ). Both patient and her mother reported that these chilblain-like lesions had never occurred before, and were not accompanied by pain or itching, or other systemic symptoms. A family history of autoimmune diseases has not been reported and the patient's mother denied that her daughter suffered from other diseases or that she recently had exposure to the cold. The patient's mother reported 1 day fever occurred, 10 days before, with a single body temperature spike of 

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