Clustered cases of acral perniosis: Clinical features, histopathology, and relationship to COVID‐19

Pediatric Dermatology - Tập 37 Số 3 - Trang 419-423 - 2020
Kelly M. Cordoro1, Sean Reynolds1, Rachel L Wattier2, Timothy H. McCalmont3
1Department of Dermatology and Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, CA, USA
2Department of Pediatrics, Division of Infectious Diseases and Global Health, University of California San Francisco, Benioff Children's Hospital, San Francisco, CA, USA
3Department of Dermatology and Pathology, University of California San Francisco, San Francisco, CA, USA

Tóm tắt

AbstractBackground/ObjectivesA recent marked increase in pediatric and adult patients presenting with purpuric acral lesions concerning for ischemia, thrombosis and necrosis has been observed in COVID‐19 prevalent regions worldwide. The clinical and histopathological features and relationship to COVID‐19 have not been well described. The objective of this case series is to describe the clinical features and determine the histopathologic findings and clinical implications of the clusters of acral perniosis cases identified in pediatric patients.MethodsWe describe six otherwise healthy adolescents—three siblings per family from two unrelated families—presented within a 48‐hour period in April, 2020, with acral perniosis‐like lesions in the context of over 30 similar patients who were evaluated within the same week.ResultsAffected patients had mild symptoms of viral upper respiratory infection (URI) or contact with symptomatic persons 1‐2 weeks preceding the rash. They all presented with red to violaceous macules and dusky, purpuric plaques scattered on the mid and distal aspects of the toes. Skin biopsies performed on each of the six patients demonstrated near identical histopathologic findings to those of idiopathic perniosis, with a lymphocytic inflammatory infiltrate without evidence of thromboembolism or immune complex vasculitis. While SARS‐CoV‐2 polymerase chain reaction was negative, testing was performed 1‐2 weeks after URI symptoms or sick contact exposure.ConclusionWe offer a clinical approach to evaluation of patients with this presentation and discuss the possibility that these skin findings represent a convalescent‐phase cutaneous reaction to SARS‐CoV‐2 infection.

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Pediatric Dermatology

Tập 37 Số 3

419-423

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