The differing pathophysiologies that underlie COVID-19-associated perniosis and thrombotic retiform purpura: a case series.
Adolescent
Age Factors
Aged
Biopsy
COVID-19
/ complications
Caspase 3
/ immunology
Chilblains
/ diagnosis
Diagnosis, Differential
Female
Foot
Hand
Humans
Interferon Type I
/ immunology
Interleukin-6
/ immunology
Livedo Reticularis
/ diagnosis
Male
Middle Aged
Myxovirus Resistance Proteins
/ analysis
Purpura
/ diagnosis
RNA, Viral
/ isolation & purification
SARS-CoV-2
/ genetics
Severity of Illness Index
Skin
/ immunology
Spike Glycoprotein, Coronavirus
/ immunology
Journal
The British journal of dermatology
ISSN: 1365-2133
Titre abrégé: Br J Dermatol
Pays: England
ID NLM: 0004041
Informations de publication
Date de publication:
01 2021
01 2021
Historique:
accepted:
18
07
2020
pubmed:
12
8
2020
medline:
20
1
2021
entrez:
12
8
2020
Statut:
ppublish
Résumé
There are two distinctive acral manifestations of COVID-19 embodying disparate clinical phenotypes. One is perniosis occurring in mildly symptomatic patients, typically children and young adults; the second is the thrombotic retiform purpura of critically ill adults with COVID-19. To compare the clinical and pathological profiles of these two different cutaneous manifestations of COVID-19. We compared the light microscopic, phenotypic, cytokine and SARS-CoV-2 protein and RNA profiles of COVID-19-associated perniosis with that of thrombotic retiform purpura in critical patients with COVID-19. Biopsies of COVID-19-associated perniosis exhibited vasocentric and eccrinotropic T-cell- and monocyte-derived CD11c COVID-19-associated perniosis represents a virally triggered exaggerated immune reaction with significant type I interferon signaling. This is important to SARS-CoV-2 eradication and has implications in regards to a more generalized highly inflammatory response. We hypothesize that in the thrombotic retiform purpura of critically ill patients with COVID-19, the vascular thrombosis in the skin and other organ systems is associated with a minimal interferon response. This allows excessive viral replication with release of viral proteins that localize to extrapulmonary endothelium and trigger extensive complement activation.
Sections du résumé
BACKGROUND
There are two distinctive acral manifestations of COVID-19 embodying disparate clinical phenotypes. One is perniosis occurring in mildly symptomatic patients, typically children and young adults; the second is the thrombotic retiform purpura of critically ill adults with COVID-19.
OBJECTIVES
To compare the clinical and pathological profiles of these two different cutaneous manifestations of COVID-19.
METHODS
We compared the light microscopic, phenotypic, cytokine and SARS-CoV-2 protein and RNA profiles of COVID-19-associated perniosis with that of thrombotic retiform purpura in critical patients with COVID-19.
RESULTS
Biopsies of COVID-19-associated perniosis exhibited vasocentric and eccrinotropic T-cell- and monocyte-derived CD11c
CONCLUSIONS
COVID-19-associated perniosis represents a virally triggered exaggerated immune reaction with significant type I interferon signaling. This is important to SARS-CoV-2 eradication and has implications in regards to a more generalized highly inflammatory response. We hypothesize that in the thrombotic retiform purpura of critically ill patients with COVID-19, the vascular thrombosis in the skin and other organ systems is associated with a minimal interferon response. This allows excessive viral replication with release of viral proteins that localize to extrapulmonary endothelium and trigger extensive complement activation.
Identifiants
pubmed: 32779733
doi: 10.1111/bjd.19415
pmc: PMC7405151
doi:
Substances chimiques
IL6 protein, human
0
Interferon Type I
0
Interleukin-6
0
MX1 protein, human
0
Myxovirus Resistance Proteins
0
RNA, Viral
0
Spike Glycoprotein, Coronavirus
0
spike protein, SARS-CoV-2
0
CASP3 protein, human
EC 3.4.22.-
Caspase 3
EC 3.4.22.-
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
141-150Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.
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