Chilblain-like acral lesions during the COVID-19 pandemic ("COVID toes"): Histologic, immunofluorescence, and immunohistochemical study of 17 cases.
Adolescent
Adult
Betacoronavirus
/ immunology
Biopsy
COVID-19
Chilblains
/ diagnosis
Coronavirus Infections
/ complications
Diagnosis, Differential
Female
Fluorescent Antibody Technique
France
Humans
Immunohistochemistry
Male
Middle Aged
Pandemics
Pneumonia, Viral
/ complications
SARS-CoV-2
Skin
/ immunology
Skin Diseases
/ diagnosis
Toes
Young Adult
COVID-19
SARS-CoV-2
chilblains
dermatopathology
direct immunofluorescence
eosinophils
immunohistochemistry
Journal
Journal of the American Academy of Dermatology
ISSN: 1097-6787
Titre abrégé: J Am Acad Dermatol
Pays: United States
ID NLM: 7907132
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
11
05
2020
accepted:
23
05
2020
pubmed:
6
6
2020
medline:
8
9
2020
entrez:
6
6
2020
Statut:
ppublish
Résumé
During the coronavirus disease 2019 pandemic, several acral chilblain-like lesions were observed in young patients with suspected, but mostly unconfirmed, infection with severe acute respiratory syndrome coronavirus 2. The histopathologic aspect of these lesions is as yet poorly known. To investigate the pathologic features of chilblain-like lesions. Biopsies were obtained from 17 cases of chilblain-like lesions during the coronavirus disease 2019 pandemic in France and were studied by routine histologic examination, immunohistochemistry, and direct immunofluorescence. The patients had suspected but unconfirmed infection with severe acute respiratory syndrome coronavirus 2 (negative nasopharyngeal polymerase chain reaction and serologic test results). Chilblain-like lesions showed many features in common with those reported in idiopathic and autoimmune-related chilblains, including epidermal necrotic keratinocytes, dermal edema, perivascular and perieccrine sweat gland lymphocytic (predominantly CD3/CD4 Chilblain-like lesions show histopathologic features similar to those of idiopathic and autoimmune-related chilblains, with a high rate of vascular changes and direct immunofluorescence positivity. The role of severe acute respiratory syndrome coronavirus 2 in the development of these puzzling lesions remains to be elucidated.
Sections du résumé
BACKGROUND
During the coronavirus disease 2019 pandemic, several acral chilblain-like lesions were observed in young patients with suspected, but mostly unconfirmed, infection with severe acute respiratory syndrome coronavirus 2. The histopathologic aspect of these lesions is as yet poorly known.
OBJECTIVE
To investigate the pathologic features of chilblain-like lesions.
METHODS
Biopsies were obtained from 17 cases of chilblain-like lesions during the coronavirus disease 2019 pandemic in France and were studied by routine histologic examination, immunohistochemistry, and direct immunofluorescence. The patients had suspected but unconfirmed infection with severe acute respiratory syndrome coronavirus 2 (negative nasopharyngeal polymerase chain reaction and serologic test results).
RESULTS
Chilblain-like lesions showed many features in common with those reported in idiopathic and autoimmune-related chilblains, including epidermal necrotic keratinocytes, dermal edema, perivascular and perieccrine sweat gland lymphocytic (predominantly CD3/CD4
CONCLUSIONS
Chilblain-like lesions show histopathologic features similar to those of idiopathic and autoimmune-related chilblains, with a high rate of vascular changes and direct immunofluorescence positivity. The role of severe acute respiratory syndrome coronavirus 2 in the development of these puzzling lesions remains to be elucidated.
Identifiants
pubmed: 32502585
pii: S0190-9622(20)31022-7
doi: 10.1016/j.jaad.2020.05.145
pmc: PMC7265862
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
870-875Informations de copyright
Copyright © 2020 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
Références
Br J Dermatol. 2020 Jul;183(1):71-77
pubmed: 32348545
J Am Acad Dermatol. 2020 May;82(5):e177
pubmed: 32213305
JAAD Case Rep. 2020 Apr 18;6(6):489-492
pubmed: 32363225
Clin Exp Dermatol. 2020 Aug;45(6):746-748
pubmed: 32302422
JAMA Dermatol. 2020 Jul 1;156(7):819-820
pubmed: 32352486
World J Gastroenterol. 2020 Apr 14;26(14):1546-1553
pubmed: 32327904
Int J Dermatol. 2018 May;57(5):596-598
pubmed: 29318596
Am J Dermatopathol. 2018 Apr;40(4):265-271
pubmed: 28719438
N Engl J Med. 2020 Jun 4;382(23):2268-2270
pubmed: 32294339
J Thromb Haemost. 2020 May;18(5):1094-1099
pubmed: 32220112
Int J Dermatol. 2020 Jun;59(6):739-743
pubmed: 32329897
Medicine (Baltimore). 2001 May;80(3):180-8
pubmed: 11388094
J Eur Acad Dermatol Venereol. 2020 Aug;34(8):e346-e347
pubmed: 32330324
J Am Acad Dermatol. 2020 Jul;83(1):280-285
pubmed: 32305439
N Engl J Med. 2020 Feb 20;382(8):727-733
pubmed: 31978945
J Eur Acad Dermatol Venereol. 2020 Jul;34(7):e291-e293
pubmed: 32330334
Lancet. 2020 May 2;395(10234):1417-1418
pubmed: 32325026
J Am Acad Dermatol. 2020 Aug;83(2):667-670
pubmed: 32380219
Am J Dermatopathol. 2010 Feb;32(1):19-23
pubmed: 20098080
J Am Acad Dermatol. 2020 Aug;83(2):700
pubmed: 32283229
J Dermatol Sci. 2020 May;98(2):75-81
pubmed: 32381430
Hum Pathol. 1997 Apr;28(4):478-84
pubmed: 9104949
JAMA Dermatol. 2020 Jul 1;156(7):820-822
pubmed: 32352487
J Am Acad Dermatol. 2001 Dec;45(6):924-9
pubmed: 11712041