A Case of Flexural Exanthema as a Presenting Sign for COVID-19

Raquel Oliveira; Margarida  Gonçalo; Carlos Faria; David Donaire; Benilde Barbosa; José Carlos Cardoso; Maria José Julião; José Moura; Armando Carvalho

doi:10.29021/spdv.78.3.1248

Raquel Oliveira Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Margarida Gonçalo Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Clinic of Dermatology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal http://orcid.org/0000-0001-6842-1360
Carlos Faria Department of Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
David Donaire Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Benilde Barbosa Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
José Carlos Cardoso Department of Dermatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Clinic of Dermatology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Maria José Julião Department of Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
José Moura Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; University Clinic of Internal Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Armando Carvalho Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; University Clinic of Internal Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

DOI: https://doi.org/10.29021/spdv.78.3.1248

Keywords: Coronavirus Infections, COVID-19, Exanthema, SARS-CoV-2

Abstract

We report a case of a 84-year-old male hospitalized for bacterial pneumonia who, during hospitalization, developed a flexural exanthema in parallel with a positive swab for SARS-CoV-2. Supportive therapy was instituted, the rash disappeared in 7 days and the patient fully recovered. At the same time, two other cases of SARS-CoV-2 infection occurred in the same ward. Histopathology and immunohistochemistry of a skin biopsy showed a scarce predominantly perivascular lymphocytic infiltration in the upper dermis, predominantly by CD4+ T cells, a slight epidermotropism, spongiosis and focal parakeratosis, compatible with a viral exanthema or a maculopapular drug eruption. Patch testing with possible culprit drugs were negative. We seek to add value in understanding all the manifestations of SARS-CoV-2 infection and to draw attention to the importance of early identification of skin manifestations in association with COVID-19.

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