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Russo R, Cozzani E, Micalizzi C, Parodi A. Chilblain-like Lesions after COVID-19 Vaccination: A Case Series. Acta Derm Venereol 2022; 102:adv00711. [PMID: 35229165 PMCID: PMC9574678 DOI: 10.2340/actadv.v102.2076] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Science (DISSAL), University of Genoa, IT-16132 Genoa, Italy.
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2
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Pararajasingam A, Bradley RE, Evans J, Lowe A, Goodwin R, Jolles S. Case Report: Generalised Panniculitis as a Post-COVID-19 Presentation in Aicardi-Goutières Syndrome Treated With Ruxolitinib. Front Pediatr 2022; 10:837568. [PMID: 35547545 PMCID: PMC9085217 DOI: 10.3389/fped.2022.837568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/01/2022] [Indexed: 12/15/2022] Open
Abstract
Aicardi-Goutières syndrome (AGS) is a rare hereditary early-onset encephalopathy. The syndrome was first described in 1984, and is characterised by upregulation of the type I interferon (IFN) pathway, which is involved in the host immune response against viral infections, including SARS-CoV-2. Whilst defects in type I IFN pathways have been described in association with severe coronavirus disease 2019 (COVID-19), less is known about the outcomes of upregulation. We describe an unusual case of generalised panniculitis as a post-COVID-19 phenomenon in a child with AGS. Our patient was initially managed with systemic steroid therapy, but due to relapse of symptoms on weaning, an alternative therapy was sought. In this case, a novel use of ruxolitinib, a JAK inhibitor, has resulted in lasting remission without complications. We discuss the probable protective role of IFN upregulation following COVID-19 infection in AGS and possible immunological mechanisms driving the panniculitis and therapeutic response in our case.
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Affiliation(s)
- Abirami Pararajasingam
- Department of Dermatology, Aneurin Bevan University Health Board, Newport, United Kingdom
| | - Rachel E Bradley
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom
| | - Jennifer Evans
- Department of Paediatrics, University Hospital of Wales, Cardiff, United Kingdom
| | - Ashima Lowe
- Department of Dermatology, Aneurin Bevan University Health Board, Newport, United Kingdom
| | - Richard Goodwin
- Department of Dermatology, Aneurin Bevan University Health Board, Newport, United Kingdom
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom
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3
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Robustelli Test E, Sena P, Locatelli AG, Carugno A, di Mercurio M, Moggio E, Gambini DM, Arosio MEG, Callegaro A, Morotti D, Gianatti A, Vezzoli P. RNAscope in situ hybridization and RT-PCR for detection of SARS-CoV-2 in chilblain-like lesions: A clinical, laboratory and histopathological study. Pediatr Dermatol 2022; 39:77-83. [PMID: 34989043 DOI: 10.1111/pde.14903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 11/16/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, an increasing number of chilblain-like lesions (ChLL) have been increasingly reported worldwide. To date, the causal link between ChLL and SARS-CoV-2 infection has not been unequivocally established. METHODS In this case series, we present demographic, clinical, laboratory, and histopathological information regarding 27 young patients with a clinical diagnosis of ChLL who referred to the Dermatology Unit of Papa Giovanni XXIII Hospital, Bergamo, Italy, from 1 April 2020 to 1 June 2020. RESULTS The mean age was 14.2 years, and 21 patients (78%) experienced mild systemic symptoms a median of 28 days before the onset of cutaneous lesions. ChLL mostly involved the feet (20 patients - 74%). Among acral lesions, we identified three different clinical patterns: (i) chilblains in 20 patients (74%); (ii) fixed erythematous macules in 4 children (15%); (iii) erythrocyanosis in 3 female patients (11%). Blood examinations and viral serologies, including parvovirus B19, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and coxsackievirus were normal in all. Three patients (11%) underwent nasopharyngeal swab for RT-PCR for SARS-CoV-2 showing only 1 positive. Histopathological examinations of 7 skin biopsies confirmed the clinical diagnosis of chilblains; vessel thrombi were observed only in 1 case. Our findings failed to demonstrate the direct presence of SARS-CoV-2 RNA in skin biopsies, both with real-time polymerase chain reaction (RT-PCR) and RNAscope in situ hybridization (ISH). LIMITATIONS Limited number of cases, unavailability of laboratory confirmation of COVID-19 in all patients, potential methodological weakness, and latency of skin biopsies in comparison to cutaneous lesions onset. CONCLUSIONS These observations may support the hypothesis of an inflammatory pathogenesis rather than the presence of peripheral viral particles. Although, we could not exclude an early phase of viral endothelial damage followed by an IFN-I or complement-mediated inflammatory phase. Further observations on a large number of patients are needed to confirm this hypothesis.
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Affiliation(s)
| | - Paolo Sena
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Erica Moggio
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Marco Enrico Giovanni Arosio
- Microbiology and Virology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.,Biobank Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Annapaola Callegaro
- Microbiology and Virology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.,Biobank Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Denise Morotti
- Pathology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Pamela Vezzoli
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
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4
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Maanaoui S, Salez F, Carpentier O. Recurrence of chilblains during a second contact with SARS-CoV-2: a case report. Br J Dermatol 2021; 185:227-228. [PMID: 33733452 PMCID: PMC8251053 DOI: 10.1111/bjd.20070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 12/16/2022]
Affiliation(s)
- S Maanaoui
- Service de Dermatologie, Centre Hospitalier de Roubaix, Roubaix, F-59100, France
| | - F Salez
- Service de Pneumologie, Centre Hospitalier de Roubaix, F-59100, Roubaix, France
| | - O Carpentier
- Service de Dermatologie, Centre Hospitalier de Roubaix, Roubaix, F-59100, France
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5
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Neri I, Conti F, Virdi A, Guglielmo A, Leonardi L, Corsini I, Ghizzi C, Gabrielli L, Lazzarotto T, Lanari M, Patrizi A, Misciali C. Chilblains in a child with confirmed SARS-CoV-2 infection: a red flag for late-onset skin manifestation in previously infected individuals. J Eur Acad Dermatol Venereol 2021; 35:e357-e359. [PMID: 33651419 PMCID: PMC8013844 DOI: 10.1111/jdv.17194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/06/2021] [Accepted: 02/18/2021] [Indexed: 12/24/2022]
Affiliation(s)
- I Neri
- Dermatology Division - IRCCS Policlinico di Sant'Orsola, Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Italy
| | - F Conti
- Pediatric Unit, Department of Woman, Child and Urologic Diseases, S. Orsola-Malpighi Hospital Scientific Institute for Research and Healthcare (IRCCS), Bologna, Italy
| | - A Virdi
- Dermatology Division - IRCCS Policlinico di Sant'Orsola, Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Italy
| | - A Guglielmo
- Dermatology Division - IRCCS Policlinico di Sant'Orsola, Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Italy
| | - L Leonardi
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - I Corsini
- Pediatric Emergency Unit, Department of Medical and Surgical Sciences (DIMEC), St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - C Ghizzi
- UOC Pediatria, Maggiore Hospital, AUSL di Bologna, Bologna, Italy
| | - L Gabrielli
- Operative Unit of Microbiology and Virology, Department of Specialized, Experimental, and Diagnostic Medicine, Polyclinic of St Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - T Lazzarotto
- Operative Unit of Microbiology and Virology, Department of Specialized, Experimental, and Diagnostic Medicine, Polyclinic of St Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - M Lanari
- Pediatric Emergency Unit, Department of Medical and Surgical Sciences (DIMEC), St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A Patrizi
- Dermatology Division - IRCCS Policlinico di Sant'Orsola, Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Italy
| | - C Misciali
- Dermatology Division - IRCCS Policlinico di Sant'Orsola, Dermatology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum, University of Bologna, Italy
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6
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Burlando M, Russo R, Cozzani E, Parodi A. Six months into the pandemic. A review of skin manifestations in SARS-CoV-2 infection. Dermatol Ther 2020; 34:e14641. [PMID: 33278049 PMCID: PMC7883133 DOI: 10.1111/dth.14641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 01/08/2023]
Abstract
During the COVID‐19 pandemic, various cutaneous manifestations have been described as associated with SARS‐CoV2 infection. It is debated if skin lesions could represent a diagnostic or prognostic indicator. Specifically, it is unclear whether skin lesions may be used to perform an early diagnosis and/or to predict worse outcomes. In this review, we described the cutaneous signs so far reported as COVID‐19‐related and discussed their incidence, clinico‐pathological features, and diagnostic and prognostic value.
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Affiliation(s)
- Martina Burlando
- Department of Dermatology, University of Genoa, Genoa, Italy.,Department of Dermatology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Roberto Russo
- Department of Dermatology, University of Genoa, Genoa, Italy.,Department of Dermatology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Emanuele Cozzani
- Department of Dermatology, University of Genoa, Genoa, Italy.,Department of Dermatology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Aurora Parodi
- Department of Dermatology, University of Genoa, Genoa, Italy.,Department of Dermatology, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
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7
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Le Cleach L, Fourati S, Sbidian E, Beylot‐Barry M. Negative tests for SARS‐CoV‐2 infection do not rule out its responsibility for chilblains: reply from the authors. Br J Dermatol 2020; 183:1151-1152. [PMID: 32790922 PMCID: PMC7436867 DOI: 10.1111/bjd.19486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/10/2020] [Indexed: 11/29/2022]
Affiliation(s)
- L. Le Cleach
- Departments ofDepartment of DermatologyHôpital Henri Mondor CréteilFrance
| | - S. Fourati
- Department of Virology Hôpital Henri Mondor Créteil France
| | - E. Sbidian
- Departments ofDepartment of DermatologyHôpital Henri Mondor CréteilFrance
| | - M. Beylot‐Barry
- Department of Dermatology University Hospital Bordeaux Bordeaux France
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8
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Bessis D. Impaired type I interferon response in SARS-CoV-2 infection: looking through the cutaneous window. Br J Dermatol 2020; 184:11-12. [PMID: 33249567 PMCID: PMC7753291 DOI: 10.1111/bjd.19596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 12/11/2022]
Abstract
Linked Article: Magro et al. Br J Dermatol 2021; 184:141–150.
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Affiliation(s)
- D Bessis
- Department of Dermatology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France.,INSERM U1058, Montpellier, France
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