Clustered cases of acral perniosis: Clinical features, histopathology, and relationship to COVID‐19
Top Cited Papers
- 12 May 2020
- journal article
- research article
- Published by Wiley in Pediatric Dermatology
- Vol. 37 (3), 419-423
- https://doi.org/10.1111/pde.14227
Abstract
Background/Objectives There has been a recent marked increase in pediatric and adult patients presenting with purpuric acral lesions concerning for ischemia, thrombosis and necrosis 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. Methods We describe 6 otherwise healthy adolescents – 3 siblings per family from 2 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. Results Affected 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 6 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. Conclusion We 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.This publication has 13 references indexed in Scilit:
- Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19The New England Journal of Medicine, 2020
- Coronavirus (COVID-19) infection–induced chilblains: A case report with histopathologic findingsJAAD Case Reports, 2020
- Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020Morbidity and Mortality Weekly Report (MMWR), 2020
- Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infectionsPublished by Cold Spring Harbor Laboratory ,2020
- Familial Chilblain Lupus - What Can We Learn from Type I Interferonopathies?Current Rheumatology Reports, 2017
- Vasospasm Is a Consistent Finding in Pernio (Chilblains) and a Possible Clue to PathogenesisDermatology, 2015
- Clinical Characteristics, Etiologic Associations, Laboratory Findings, Treatment, and Proposal of Diagnostic Criteria of Pernio (Chilblains) in a Series of 104 Patients at Mayo Clinic, 2000 to 2011Mayo Clinic Proceedings, 2014
- Regulation of type I interferon responsesNature Reviews Immunology, 2013
- Major cluster of chilblain cases in a cold dry Western Australian winterJournal of Paediatrics and Child Health, 2013
- Childhood Pernio and CryoproteinsPediatric Dermatology, 2000