Systemic lupus erythematosus, varicella-like rash, and COVID-19.

To the Editor,

We would like to shared ideas on the report on “Systemic lupus erythematosus and varicella‐like rash following COVID‐19. ” Slimani et al.  mentioned that “COVID‐19 triggered systemic lupus erythematosus (SLE) has never been reported to our knowledge.” The atypical clinical presentation in coronavirus disease 2019 (COVID‐19) is possible and there are many skin disorder caused by immunopathological process due to COVID‐19. For SLE, there has already been a previous report on SLE and COVID‐19 with possible antiphospholipid syndrome. The copresentation is might be a coincidence and it is not possible to prove that COVID‐19 triggers SLE in the case report. Finally, the cross‐reaction by serological test for SLE and COVID‐19 is possible and this is an important consideration in diagnosing COVID‐19 and possible COVID‐19‐related immune disorder. Focusing on a varicella‐like rash, it is a possible skin lesion in COVID‐19. A remained question is also whether there is a concurrent between COVID‐19 and varicella in the patient. The coinfection has just been reported in a pediatric COVID‐19 case. There should be a proof to rule out varicella in the patient before making a conclusion that the problem is COVID‐19‐related varicella‐like lesion.