Scientific Letter
Cutaneous manifestations in the current pandemic of coronavirus infection disease (COVID 2019)
Manifestaciones cutáneas en contexto del brote actual de enfermedad por coronavirus 2019
Miriam Morey-Olivéa, María Espiaua,
, Maria Mercadal-Hallyb, Esther Lera-Carballoc, Vicenç García-Patosd
Corresponding author
a Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Universitari Vall d’Hebron, Barcelona, Spain
b Unidad de Hepatología y Trasplante Hepático Pediátrico, Hospital Universitari Vall d’Hebron, Barcelona, Spain
c Unidad de Urgencias Pediátricas, Hospital Universitari Vall d’Hebron, Barcelona, Spain
d Servicio de Dermatología, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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United European Gastroenterol J. 2017;5:335–58). <span class="elsevierStyleSup">1</span> In patienteswith persistent symtoms under anti-inflammatory therapy, endoscopic dilation should be considered. <span class="elsevierStyleSup">2</span> Refer the patient to an EoE center.</p>" ] ] ] "autores" => array:2 [ 0 => array:2 [ "autoresLista" => "Carolina Gutiérrez Junquera, Sonia Fernández Fernández, Gloria Domínguez-Ortega, Víctor Vila Miravet, Roger García Puig, Ruth García Romero, Ana Fernández de Valderrama, Rebeca Andradas Rivas" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Carolina" "apellidos" => "Gutiérrez Junquera" ] 1 => array:2 [ "nombre" => "Sonia" "apellidos" => "Fernández Fernández" ] 2 => array:2 [ "nombre" => "Gloria" "apellidos" => "Domínguez-Ortega" ] 3 => array:2 [ "nombre" => "Víctor" "apellidos" => "Vila Miravet" ] 4 => array:2 [ "nombre" => "Roger" "apellidos" => "García Puig" ] 5 => array:2 [ "nombre" => "Ruth" "apellidos" => "García Romero" ] 6 => array:2 [ "nombre" => "Ana" "apellidos" => "Fernández de Valderrama" ] 7 => array:2 [ "nombre" => "Rebeca" "apellidos" => "Andradas Rivas" ] 8 => array:1 [ "colaborador" => "Grupo de Trabajo de Trastornos Gastrointestinales Eosinofílicos de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátricas (SEGHNP)" ] ] ] 1 => array:2 [ "autoresLista" => "" "autores" => array:1 [ 0 => array:1 [ "colaborador" => "Miembros del Grupo de Trabajo de Trastornos Gastrointestinales Eosinofílicos de la Sociedad Española de Gastroenterología, Hepatología y Nutrición Pediátricas (SEGHNP)" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403320301594" "doi" => "10.1016/j.anpedi.2020.04.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403320301594?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287920300776?idApp=UINPBA00005H" "url" => "/23412879/0000009200000006/v1_202006250819/S2341287920300776/v1_202006250819/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287920300661" "issn" => "23412879" "doi" => "10.1016/j.anpede.2020.04.001" "estado" => "S300" "fechaPublicacion" => "2020-06-01" "aid" => "2846" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2020;92:373-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "COVID-19: Fever syndrome and neurological symptoms in a neonate" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "373" "paginaFinal" => "374" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "COVID-19: Síndrome febril y clínica neurológica en neonato" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rocío Chacón-Aguilar, Juana María Osorio-Cámara, Isabel Sanjurjo-Jimenez, Carolina González-González, Juan López-Carnero, B. 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array:1 [ 0 => array:2 [ "paginaInicial" => "374" "paginaFinal" => "375" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Miriam Morey-Olivé, María Espiau, Maria Mercadal-Hally, Esther Lera-Carballo, Vicenç García-Patos" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Miriam" "apellidos" => "Morey-Olivé" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "María" "apellidos" => "Espiau" "email" => array:1 [ 0 => "mariaespiau@upiip.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Maria" "apellidos" => "Mercadal-Hally" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Esther" "apellidos" => "Lera-Carballo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Vicenç" "apellidos" => "García-Patos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Universitari Vall d’Hebron, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Hepatología y Trasplante Hepático Pediátrico, Hospital Universitari Vall d’Hebron, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad de Urgencias Pediátricas, Hospital Universitari Vall d’Hebron, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitari Vall d’Hebron, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Manifestaciones cutáneas en contexto del brote actual de enfermedad por coronavirus 2019" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 991 "Ancho" => 755 "Tamanyo" => 74993 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Urticaria-like exanthem in patient 2.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Infection by novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2), first identified in 2019 in Wuhan, China, is the aetiological agent of the coronavirus disease 2019 (COVID-19).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> At present, it has spread to become a global pandemic that, according to the World Health Organization, affects more than one and a half million people throughout the world.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> When the COVID-19 outbreak was first described, there were only exceptional cases in the paediatric population, but as the outbreak spread the number of reported cases in children has grown, with most affected patients having mild or no symptoms.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most frequent manifestations include fever, dry cough, sore throat, headache, asthenia, myalgia and respiratory distress. To date, cutaneous manifestations in association with COVID-19 have only been described in adults.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Given the scarce information on these symptoms in the paediatric population, we present the cases of 2 paediatric patients with infection by SARS-CoV-2 with cutaneous manifestations.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The first case corresponded to a boy aged 6 years admitted to hospital for evaluation of cholestatic liver disease of unknown aetiology. At 2 weeks, after the patient developed a low-grade fever and a worsening of the markers for cholestasis and cytolytic hepatitis, he was tested for SARS-CoV-2 and turned out positive. Forty-eight hours later, the patient developed an erythematous, confluent, nonpruritic maculopapular rash with onset in the trunk and neck that gradually spread to the cheeks and upper and lower extremities, reaching the palms of the hands (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The cutaneous manifestations lasted a total of 5 days and resolved with no complications and without specific treatment. Improvement in the rash was associated with improvement in laboratory markers (bilirubin, transaminases and coagulation parameters). In light of the worsening of liver disease associated with the positive PCR result for SARS-CoV-2 in a nasopharyngeal swab sample, we performed a PCR test on a liver biopsy sample obtained in the initial evaluation of the patient, which was negative. During hospitalization, the patient did not exhibit any other manifestations related to infection by coronavirus.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The second case corresponded to a girl aged 2 months brought to the emergency department due to a low-grade fever and acute urticaria, apparently pruritic, of 4 days’ duration. The rash was initially located in the face and upper extremities and spread in a few hours to the trunk and lower extremities (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The palms and soles were not affected. The patient had no angioedema in the fingers, toes, lips or tongue.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The most relevant epidemiological feature of the history was cohabitation with 2 individuals with confirmed COVID-19, which prompted performance of a SARS-CoV-2 PCR test on a nasopharyngeal swab sample that turned out positive. The patient received oral symptomatic treatment with a favorable response. Most lesions healed within 24<span class="elsevierStyleHsp" style=""></span>h, and the cutaneous manifestations resolved in 5 days in the absence of any other signs and symptoms.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the adult population, cutaneous manifestations in the context of COVID-19 have been described in a case series of 18 adult patients in Lombardy, Italy. These patients presented with nonpruritic rashes that were erythematous, urticaria-like or, in 1 case, a vesicular varicella-like rash.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Another case was reported in Thailand in a patient with petechial exanthem that, on account of its characteristics, was initially misdiagnosed as dengue fever.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Based on the evidence published to date,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> the cutaneous manifestations of novel coronavirus are similar to those caused by other common viral infections. There is no evidence that the extent of cutaneous involvement is related to the severity of disease.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> We ought to consider that in addition to the exanthems characteristic of the acute phase of infection described in this article, there have been recent reports of acral and/or chilblain-like lesions in children and youth who are otherwise asymptomatic that could be a late manifestation of inflammatory processes or microthrombotic events in the immune phase of disease.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Contrary to what we observed in our patients, all described adult patients with cutaneous manifestations also had respiratory symptoms during the course of disease and could have received treatment for them. Thus, we also need to consider the possibility of cutaneous manifestations being adverse drug reactions.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Our observations reveal that it is possible for paediatric patients with COVID-19 to present with a rash that may be attributed to other common childhood diseases as the only manifestation or in association with mild symptoms. Given the current circumstances and the measures that have been instituted to prevent transmission in patients with suspected or confirmed COVID-19, it is particularly important to be aware of these manifestations as part of the clinical picture of the disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Morey-Olivé M, Espiau M, Mercadal-Hally M, Lera-Carballo E, García-Patos V. Manifestaciones cutáneas en contexto del brote actual de enfermedad por coronavirus 2019. An Pediatr (Barc). 2020;92:377–378.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 994 "Ancho" => 755 "Tamanyo" => 65025 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous, confluent, nonpruritic maculopapular exanthem in patient 1.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 991 "Ancho" => 755 "Tamanyo" => 74993 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Urticaria-like exanthem in patient 2.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and CT features in pediatric patients with COVID-19 infection: different points from adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 76 | 28 | 104 |
| 2024 September | 81 | 24 | 105 |
| 2024 August | 79 | 62 | 141 |
| 2024 July | 69 | 25 | 94 |
| 2024 June | 78 | 17 | 95 |
| 2024 May | 98 | 42 | 140 |
| 2024 April | 62 | 32 | 94 |
| 2024 March | 76 | 20 | 96 |
| 2024 February | 80 | 26 | 106 |
| 2024 January | 103 | 27 | 130 |
| 2023 December | 99 | 19 | 118 |
| 2023 November | 291 | 46 | 337 |
| 2023 October | 90 | 34 | 124 |
| 2023 September | 81 | 50 | 131 |
| 2023 August | 76 | 21 | 97 |
| 2023 July | 93 | 44 | 137 |
| 2023 June | 98 | 43 | 141 |
| 2023 May | 144 | 36 | 180 |
| 2023 April | 120 | 26 | 146 |
| 2023 March | 173 | 46 | 219 |
| 2023 February | 162 | 24 | 186 |
| 2023 January | 182 | 25 | 207 |
| 2022 December | 182 | 35 | 217 |
| 2022 November | 223 | 41 | 264 |
| 2022 October | 191 | 60 | 251 |
| 2022 September | 148 | 46 | 194 |
| 2022 August | 175 | 64 | 239 |
| 2022 July | 249 | 57 | 306 |
| 2022 June | 196 | 49 | 245 |
| 2022 May | 220 | 59 | 279 |
| 2022 April | 221 | 63 | 284 |
| 2022 March | 255 | 89 | 344 |
| 2022 February | 281 | 67 | 348 |
| 2022 January | 523 | 94 | 617 |
| 2021 December | 327 | 65 | 392 |
| 2021 November | 246 | 58 | 304 |
| 2021 October | 386 | 114 | 500 |
| 2021 September | 340 | 78 | 418 |
| 2021 August | 213 | 79 | 292 |
| 2021 July | 228 | 63 | 291 |
| 2021 June | 254 | 80 | 334 |
| 2021 May | 294 | 92 | 386 |
| 2021 April | 977 | 223 | 1200 |
| 2021 March | 532 | 107 | 639 |
| 2021 February | 386 | 63 | 449 |
| 2021 January | 1720 | 92 | 1812 |
| 2020 December | 491 | 87 | 578 |
| 2020 November | 469 | 97 | 566 |
| 2020 October | 368 | 81 | 449 |
| 2020 September | 613 | 110 | 723 |
| 2020 August | 767 | 117 | 884 |
| 2020 July | 905 | 163 | 1068 |
| 2020 June | 765 | 178 | 943 |
| 2020 May | 395 | 152 | 547 |
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