Prolonged dermatological manifestation 4 weeks following recovery of COVID-19 in a child.

Description

A 12-year-old boy presents with a 2-week history of a generalised maculopapular exanthem on the trunk, arms and legs 4 weeks after a full recovery from COVID-19. During the COVID-19 acute infection (nasopharyngeal swab tested for SARS-CoV-2 RNA amplification result positive), he developed fevers greater than 39°C for 48 hours, sore throat, abdominal pain and diarrhoea lasting a week. Four weeks after full recovery of all symptoms, a generalised maculopapular rash developed, which was non-itchy on the trunk, arms and legs with no fevers or other symptoms were associated (figures 1 and 2). On day 5, cervical lymphadenopathy was palpable and a large raised scaly patch resembling a herald patch was noted on the back of the torso (figure 1). The rash persisted for 2 weeks with gradual resolution of the rash and the lymphadenopathy. Laboratory tests revealed a normal white blood cells and platelet count, normal liver and kidney function, normal C reactive protein and erythrocyte sedimentation rate. The patient remained otherwise healthy, and no medications were taken. An echocardiogram was also noted to be normal.

Figure 1

Maculopapular exanthem on the trunk.

Maculopapular rash on the legs.

There were no other symptoms apart from the cervical lymphadenopathy as patient had just recovered from COVID-19. The rash was non-itchy, and a differential diagnosis could have been pityriasis rosea due to a viral exanthema. Most causes of pityriasis rosea are unclear and are thought to be due to a viral trigger. Without any other symptoms apart from the cervical lymphadenopathy, due to the temporal effect of being infected with COVID-19, the rash and the cervical lymphadenopathy are most likely immune-mediated and triggered by SARS-CoV-2 virus.

Various cutaneous manifestations have been reported with COVID-19 during an acute clinical presentation from papulovesicular rash, urticaria, painful acral red purple papules, livedo reticularis lesions and petechiae.1 While studies have reported that timing of cutaneous manifestations associated with COVID-19 have ranged in patients, from 3 days before COVID-19 diagnosis to 13 days after diagnosis.2 There have been no reported cases of prolonged dermatological manifestations in children following recovery of COVID-19 4 weeks after diagnosis.

Cutaneous manifestations have been reported with COVID-19 during an acute clinical presentation.

Unusual prolonged dermatological manifestation from a post-COVID-19 infection has rarely been reported.

Pityriasis rosea exanthem may be part of a cutaneous manifestations associated with COVID-19.