Symmetric cutaneous vasculitis in COVID-19 pneumonia.

Editor

Fever, cough, breathing difficulties, digestive issues and loss of smell and taste are the most common symptoms of novel SARS‐CoV2 infection but cutaneous manifestations have been highlighted by several dermatologists. We found reports , , to be very interesting because it was underlined how the COVID‐19 infection can also give cutaneous manifestations vasculitis – like. It has already been described how purple in children, when accompanied by fever, can be a rare but possible manifestation of novel SARs‐CoV2 infection. Autopsy shows that lungs manifest significant pathological lesions, including alveolar and interstitial inflammation, epithelium proliferation and hyaline membrane formation; infection involves also heart, vessels, liver, kidney and other organs. It seems that many macrophages but very few lymphocytes intervene in interstitium. Expression of endothelial cells could trigger a cytokine storm which recruits macrophages and causes inflammatory reactions, similar to those of vasculitis, and the activation of thrombophilic states. Starting from these considerations, we share our experience: we documented two cases of skin involvement in young subjects with moderate to severe lung involvement and poor comorbidities. In one, we saw a widespread urticarial involving the thigh region and the perimalleolar area with spontaneous resolution in a few days. The other one, presenting a severe respiratory failure with ARDS framework, showed at first a legs vasculitic purpura (Figs 1 and 2) then a fleeting erythematous rash. Itching was low and lesions healed in few days with steroid therapy. Skin manifestations were similar to cutaneous involvement occurring during autoimmune diseases. COVID‐19 can feature signs of small blood vessel occlusion. These can be petechiae or tiny bruises, and transient livedoid eruptions. Currently, there are few reports about the possible dermatological manifestations of COVID‐19; we need more experience to confirm and better understand skin involvement.

Figure 1

Purpuric rash of a leg with surrounding partially infiltrated rash areas.

Figure 2

Purpuric rash of a knee.

Acknowledgement

The patients in this manuscript have given written informed consent to the publication of their case details.