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reaching the palms of the hands &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The cutaneous manifestations lasted a total of 5 days and resolved with no complications and without specific treatment&#46; Improvement in the rash was associated with improvement in laboratory markers &#40;bilirubin&#44; transaminases and coagulation parameters&#41;&#46; In light of the worsening of liver disease associated with the positive PCR result for SARS-CoV-2 in a nasopharyngeal swab sample&#44; we performed a PCR test on a liver biopsy sample obtained in the initial evaluation of the patient&#44; which was negative&#46; During hospitalization&#44; the patient did not exhibit any other manifestations related to infection by coronavirus&#46;</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&#44; apparently pruritic&#44; of 4 days&#8217; duration&#46; The rash was initially located in the face and upper extremities and spread in a few hours to the trunk and lower extremities &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The palms and soles were not affected&#46; The patient had no angioedema in the fingers&#44; toes&#44; lips or tongue&#46;</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&#44; which prompted performance of a SARS-CoV-2 PCR test on a nasopharyngeal swab sample that turned out positive&#46; The patient received oral symptomatic treatment with a favorable response&#46; Most lesions healed within 24<span class="elsevierStyleHsp" style=""></span>h&#44; and the cutaneous manifestations resolved in 5 days in the absence of any other signs and symptoms&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the adult population&#44; cutaneous manifestations in the context of COVID-19 have been described in a case series of 18 adult patients in Lombardy&#44; Italy&#46; These patients presented with nonpruritic rashes that were erythematous&#44; urticaria-like or&#44; in 1 case&#44; a vesicular varicella-like rash&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Another case was reported in Thailand in a patient with petechial exanthem that&#44; on account of its characteristics&#44; was initially misdiagnosed as dengue fever&#46;<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&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> the cutaneous manifestations of novel coronavirus are similar to those caused by other common viral infections&#46; There is no evidence that the extent of cutaneous involvement is related to the severity of disease&#46;<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&#44; there have been recent reports of acral and&#47;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&#46;<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&#44; all described adult patients with cutaneous manifestations also had respiratory symptoms during the course of disease and could have received treatment for them&#46; Thus&#44; we also need to consider the possibility of cutaneous manifestations being adverse drug reactions&#46;</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&#46; Given the current circumstances and the measures that have been instituted to prevent transmission in patients with suspected or confirmed COVID-19&#44; it is particularly important to be aware of these manifestations as part of the clinical picture of the disease&#46;</p></span>"
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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,
Corresponding author
mariaespiau@upiip.com

Corresponding author.
, Maria Mercadal-Hallyb, Esther Lera-Carballoc, Vicenç García-Patosd
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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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Infection by novel coronavirus &#40;severe acute respiratory syndrome coronavirus 2&#44; SARS-CoV-2&#41;&#44; first identified in 2019 in Wuhan&#44; China&#44; is the aetiological agent of the coronavirus disease 2019 &#40;COVID-19&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> At present&#44; it has spread to become a global pandemic that&#44; according to the World Health Organization&#44; affects more than one and a half million people throughout the world&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> When the COVID-19 outbreak was first described&#44; there were only exceptional cases in the paediatric population&#44; but as the outbreak spread the number of reported cases in children has grown&#44; with most affected patients having mild or no symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The most frequent manifestations include fever&#44; dry cough&#44; sore throat&#44; headache&#44; asthenia&#44; myalgia and respiratory distress&#46; To date&#44; cutaneous manifestations in association with COVID-19 have only been described in adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> Given the scarce information on these symptoms in the paediatric population&#44; we present the cases of 2 paediatric patients with infection by SARS-CoV-2 with cutaneous manifestations&#46;</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&#46; At 2 weeks&#44; after the patient developed a low-grade fever and a worsening of the markers for cholestasis and cytolytic hepatitis&#44; he was tested for SARS-CoV-2 and turned out positive&#46; Forty-eight hours later&#44; the patient developed an erythematous&#44; confluent&#44; nonpruritic maculopapular rash with onset in the trunk and neck that gradually spread to the cheeks and upper and lower extremities&#44; reaching the palms of the hands &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; The cutaneous manifestations lasted a total of 5 days and resolved with no complications and without specific treatment&#46; Improvement in the rash was associated with improvement in laboratory markers &#40;bilirubin&#44; transaminases and coagulation parameters&#41;&#46; In light of the worsening of liver disease associated with the positive PCR result for SARS-CoV-2 in a nasopharyngeal swab sample&#44; we performed a PCR test on a liver biopsy sample obtained in the initial evaluation of the patient&#44; which was negative&#46; During hospitalization&#44; the patient did not exhibit any other manifestations related to infection by coronavirus&#46;</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&#44; apparently pruritic&#44; of 4 days&#8217; duration&#46; The rash was initially located in the face and upper extremities and spread in a few hours to the trunk and lower extremities &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The palms and soles were not affected&#46; The patient had no angioedema in the fingers&#44; toes&#44; lips or tongue&#46;</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&#44; which prompted performance of a SARS-CoV-2 PCR test on a nasopharyngeal swab sample that turned out positive&#46; The patient received oral symptomatic treatment with a favorable response&#46; Most lesions healed within 24<span class="elsevierStyleHsp" style=""></span>h&#44; and the cutaneous manifestations resolved in 5 days in the absence of any other signs and symptoms&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In the adult population&#44; cutaneous manifestations in the context of COVID-19 have been described in a case series of 18 adult patients in Lombardy&#44; Italy&#46; These patients presented with nonpruritic rashes that were erythematous&#44; urticaria-like or&#44; in 1 case&#44; a vesicular varicella-like rash&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Another case was reported in Thailand in a patient with petechial exanthem that&#44; on account of its characteristics&#44; was initially misdiagnosed as dengue fever&#46;<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&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> the cutaneous manifestations of novel coronavirus are similar to those caused by other common viral infections&#46; There is no evidence that the extent of cutaneous involvement is related to the severity of disease&#46;<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&#44; there have been recent reports of acral and&#47;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&#46;<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&#44; all described adult patients with cutaneous manifestations also had respiratory symptoms during the course of disease and could have received treatment for them&#46; Thus&#44; we also need to consider the possibility of cutaneous manifestations being adverse drug reactions&#46;</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&#46; Given the current circumstances and the measures that have been instituted to prevent transmission in patients with suspected or confirmed COVID-19&#44; it is particularly important to be aware of these manifestations as part of the clinical picture of the disease&#46;</p></span>"
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Article information
ISSN: 23412879
Original language: English
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Idiomas
Anales de Pediatría (English Edition)