Sandbox:Nuha

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Nuha Al-Howthi, MD[1]

chilblain‐like lesions

the lesion was red–purple papules on the dorsal aspect of the fingers on both hands and diffused erythema in the subungual area of thumb.[1]

historical respective

  • in Qater,two cases of COVID‐19 presenting with cutaneous lesions, specifically, chilblain‐like lesions.
  • Hunt and Koziatek reported a case of COVID‐19 presenting with fever and morbilliform rash as the primary presenting symptoms.[2]
  • while Joob and Wiwanitkit reported a case of COVID‐19 presenting initially with a petechial skin rash in Thailand.[3]

pathophysiology

  • Degeneration and necrosis of parenchymal cells and formation of hyaline thrombi in small vessels were observed in lung and other organs.[4]


Acute acro-ischemia in the child

  • the presentations of acro-ischemia including finger/toe cyanosis, skin bulla and dry gangrene.[5]
  • Mazzotta and Troccoli reported a few dozen cases, initially presenting with red–purple papules on the feet and hands, which either evolved into haemorrhagic bullae or developed a blackish crust.[6]

pathophysiology

they could be the expression of secondary microthrombosis due to endothelial damage and vascular disorders.[5]

lab results

  • D-dimer, fibrinogen and fibrinogen degradation product (FDP) were significantly elevated in most patients.
  • Prothrombin time was prolonged in 4 patients. D-dimer and FDP levels progressively elevated consistent with COVID-2019 exacerbation.
  • Four patients were diagnosed with disseminated intravascular coagulation (DIC) .
  • Low molecular weight heparin (LMWH) was administrated in 6 patients, which reduced D-dimer and FDP rather than improved clinical symptoms.[5]


erythematous rash

widespread urticaria

chicken‐pox like vesicles

  1. ↑ Alramthan A, Aldaraji W (2020). "Two cases of COVID-19 presenting with a clinical picture resembling chilblains: first report from the Middle East". Clin Exp Dermatol. doi:10.1111/ced.14243. PMC 7264553 Check |pmc= value (help). PMID 32302422 Check |pmid= value (help).
  2. ↑ Hunt, Madison; Koziatek, Christian (2020). "A Case of COVID-19 Pneumonia in a Young Male with Full Body Rash as a Presenting Symptom". Clinical Practice and Cases in Emergency Medicine. 4 (2). doi:10.5811/cpcem.2020.3.47349. ISSN 2474-252X.
  3. ↑ Joob B, Wiwanitkit V (2020). "COVID-19 can present with a rash and be mistaken for dengue". J Am Acad Dermatol. 82 (5): e177. doi:10.1016/j.jaad.2020.03.036. PMC 7156802 Check |pmc= value (help). PMID 32213305 Check |pmid= value (help).
  4. ↑ Yao XH, Li TY, He ZC, Ping YF, Liu HW, Yu SC; et al. (2020). "[A pathological report of three COVID-19 cases by minimal invasive autopsies]". Zhonghua Bing Li Xue Za Zhi. 49 (5): 411–417. doi:10.3760/cma.j.cn112151-20200312-00193. PMID 32172546 Check |pmid= value (help).
  5. ↑ 5.0 5.1 5.2 Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J; et al. (2020). "[Clinical and coagulation characteristics in 7 patients with critical COVID-2019 pneumonia and acro-ischemia]". Zhonghua Xue Ye Xue Za Zhi. 41 (4): 302–307. doi:10.3760/cma.j.issn.0253-2727.2020.008. PMID 32447934 Check |pmid= value (help).
  6. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.26326/2281-9649.30.2.2102 Check |pmid= value (help).
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