Periungual desquamation in a Japanese adult recovering from severe COVID-19.

We report a case of a 50-year-old Japanese male who developed periungual desquamation in hands and feet during the recovery phase of severe COVID-19. Because coronary lesions have been reported during the recovery phase of severe COVID-19 in children, as well as for Kawasaki disease, caution may also be necessary in adults.

A 50-year-old Japanese man was admitted to our hospital with a 14-day history of fever and sudden dyspnea. The patient was diagnosed with severe coronavirus disease (COVID-19) based on positive test results of RNA polymerase chain reaction for severe acute respiratory syndrome coronavirus. He was started on mechanical ventilation and extracorporeal membrane oxygenation (ECMO). He received ECMO for 23 days and was tracheostomized on hospital day (HD) 37. His general condition improved by HD 54. On HD 61, periungual desquamation appeared on the fingers of left hand (Panel 1A), left palm (Panel 1B), and both feet (Panel 1C). He satisfied the diagnostic criteria for Multisystem Inflammatory Syndrome in Children (MIS-C) other than age (Center for Disease Control and prevention, 2020). There were no other conditions, which have potentially present the periungual desquamation, such as Kawasaki disease (KD) and Toxic Shock Syndrome during hospitalization. His result of bedside echocardiography, electrocardiogram and chest X-ray have revealed no abnormalities until 4 months on admission.

Severe COVID-19 in children have been reported to present with KD-like symptoms, MIS-C, and some of these have periungual desquamation during the recovery period (Feldstein et al., 2020, Shaigany et al., 2020). Coronary artery lesions (CALs) have been reported recovering from MIS-C (Dufort et al., 2020, Feldstein et al., 2020). Therefore, it may be necessary to thoroughly assess adults with severe COVID-19 with periungual desquamation for CALs (Fig. 1 ).

Fig. 1

Periungual desquamation in an adult severe coronavirus disease patient

Periungual desquamation appeared in the fingernails (Panel 1A) and palm (Panel 1B) of the left hand and in both feet (Panel 1C) in an adult patient with severe COVID-19.

Funding source

This research was supported by AMED under Grant Number JP20he0822003.

Ethical approval

The patient provided consent for the publication of her clinical case details.

Conflict of interest

The authors state that they have no conflict of interest.

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.