Oral vesiculobullous lesions as an early sign of COVID-19: immunohistochemical detection of SARS-CoV-2 spike protein.

Dear Editor, A 23‐year‐old woman presented with vesiculobullous lesions in the lips with an erythematous halo (a, b). She also presented with fever and dry cough starting 3 days before. Polymerase chain reaction for SARS‐CoV‐2 was positive. Treatment with systemic dexamethasone resulted in complete remission of the lesions by the eighth day. Lip biopsy showed moderate lymphocytic infiltrate and microvascular thrombosis. Immunohistochemistry for the SARS‐CoV‐2 spike protein was positive in inflammatory endothelial cells and keratinocytes, and acinar and ductal cells of the minor salivary glands (c, d). Herpes simplex virus (HSV)‐1, HSV‐2, human herpesvirus‐3 and cytomegalovirus were negative. Previous studies reported oral lesions in patients with COVID‐19, but our group demonstrated microvascular thrombi by histology., To our knowledge, this is the first report showing the SARS‐CoV‐2 spike protein in oral lesions of patients with COVID‐19.

Author Contribution

Ciro Dantas Soares: Conceptualization (equal); Data curation (equal); Formal analysis (equal); Project administration (equal). Adalberto Mosqueda‐Taylor: Supervision (equal); Validation (equal); Writing‐review & editing (equal). Maria Goretti Freire Carvalho: Conceptualization (equal); Data curation (equal). Oslei Paes de Almeida: Supervision (equal); Writing‐review & editing (equal).