A clinical, histopathological and laboratory study of 19 consecutive Italian paediatric patients with chilblain‐like lesions: lights and shadows on the relationship with COVID‐19 infection

Journal of the European Academy of Dermatology and Venereology - Tập 34 Số 11 - Trang 2620-2629 - 2020
May El Hachem1, Andrea Diociaiuti1,2, Carlo Concato2,3, Rita Carsetti4, Claudia Carnevale1, Marta Luisa Ciofi degli Atti5, Luigi Giovannelli6, Ermenegilda Latella1, Ottavia Porzio7,7, Sandro Rossi8, Alessandra Stracuzzi8, Salvatore Zaffina9, Andrea Onetti Muda10, Giovanna Zambruno11, Rita Alaggio8
1Dermatology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
2Equal contribution
3Virology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
4Diagnostic Immunology Unit Department of Laboratories B Cell Pathophysiology Unit, Immunology Research Area Bambino Gesù Children’s Hospital IRCCS Rome Italy
5Clinical Epidemiology Unit, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
6Medical Laboratory Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
7Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
8Pathology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
9Occupational Medicine, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
10Department of Laboratories Bambino Gesù Children's Hospital IRCCS Rome Italy
11Genetics and Rare Diseases Research Division, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

Tóm tắt

AbstractBackgroundAcral chilblain‐like lesions are being increasingly reported during COVID‐19 pandemic. However, only few patients proved positivity for SARS‐CoV‐2 infection. The relationship between this skin manifestation and COVID‐19 infection has not been clarified yet.ObjectiveTo thoroughly characterize a prospective group of patients with chilblain‐like lesions and to investigate the possible relationship with SARS‐CoV‐2 infection.MethodsFollowing informed consent, patients underwent (i) clinical evaluation, (ii) RT‐PCR and serology testing for SARS‐CoV‐2, (iii) digital videocapillaroscopy of finger and toe nailfolds, (iv) blood testing to screen for autoimmune diseases and coagulation anomalies, and (v) skin biopsy for histopathology, direct immunofluorescence and, in selected cases, electron microscopy.ResultsNineteen patients, all adolescents (mean age: 14 years), were recruited. 11/19 (58%) of them and/or their cohabitants reported flu‐like symptoms one to two months prior to skin manifestation onset. Lesions were localized to toes and also heels and soles. Videocapillaroscopy showed pericapillary oedema, dilated and abnormal capillaries, and microhaemorrhages both in finger and toe in the majority of patients. Major pathological findings included epidermal basal layer vacuolation, papillary dermis oedema and erythrocyte extravasation, perivascular and perieccrine dermal lymphocytic infiltrate, and mucin deposition in the dermis and hypodermis; dermal vessel thrombi were observed in two cases. Blood examinations were normal. Nasopharyngeal swab for SARS‐CoV‐2 and IgG serology for SARS‐CoV‐2 nucleocapsid protein were negative. Importantly, IgA serology for S1 domain of SARS‐CoV‐2 spike protein was positive in 6 patients and borderline in 3.ConclusionsChilblain‐like lesions during COVID‐19 pandemic have specific epidemiologic, clinical, capillaroscopic and histopathological characteristics, which distinguish them from idiopathic perniosis. Though we could not formally prove SARS‐CoV‐2 infection in our patients, history data and the detection of anti‐SARS‐COV‐2 IgA strongly suggest a relationship between skin lesions and COVID‐19. Further investigations on the mechanisms of SARS‐CoV‐2 infection in children and pathogenesis of chilblain‐like lesions are warranted.

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Journal of the European Academy of Dermatology and Venereology

Tập 34 Số 11

2620-2629

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