Purpuric rash on the legs of a patient with coronavirus disease

A 30-year-old male health-care worker, who was regularly monitored at the dermatology clinic for ochre dermatitis on the medial side of the legs, reported a 15-day history of fever and diarrhea, followed by erythematous-purpuric macules and papules on the legs and feet 1 week before, involving some fingers (Figures 1A and B). He had no history of pain or itching. After 2 weeks, he returned to the clinic after testing for coronavirus disease (COVID-19) antibodies (IgM and IgG positive). The skin lesions showed considerable improvement during this period (Figure 1C) and the patient fully recovered at home.

FIGURE 1:
(A): Purpuric rashes on the anterior surface of the legs. (B): Characteristics of the lesions in the toes, resembling perniosis. (C): Clinical improvement after 2 weeks of expectant management.

The patient' clinical condition was considered a vascular skin manifestation associated with COVID-19 infection^1,2. Among the specific dermatological findings of the disease, pernio-like lesions are highlighted². Perniosis is a vascular inflammatory response occurring in the extremities and is clinically characterized by erythematous-purpuric macules and papules. This skin condition can be induced by low temperatures or can be associated with autoimmune diseases, drugs, or infections. When associated to COVID-19, pernio-like lesions are predominantly manifest in young and healthy patients, which may represent a good prognosis of the infectious condition^2,3.

Severe acute respiratory syndrome coronavirus 2 infection can affect several organ systems, including the skin¹. As Brazil is one of the most affected countries, recognizing associated skin lesions is important for the early diagnosis of COVID-19.

REFERENCE

• ¹
  Galvan CC, Catala A, Carretero HG, Rodríguez-Jiménez P, Ferández-Nieto D, Rodríguez-Villa LA, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020.
• ²
  Freeman EE, McMahon DE, Lipoff JB, Rosenbach M, Kovarik C, Takeshita J, et al. Pernio-like skin lesions associated with COVID-19: a case series of 318 patients from 8 countries. J Am Acad Dermatol. 2020;83(2):486-92.
• ³
  Bouaziz JD, Duong T, Jachiet M, Velter C, Lestang P, Cassius C, et al. Vascular skin symptoms in COVID-19: a French observational study. J Eur Acad Dermatol Venereol. 2020.

Publication Dates

• Publication in this collection
  21 Sept 2020
• Date of issue
  2020

History

• Received
  10 July 2020
• Accepted
  18 Aug 2020