tetano
Editor, Senior Moderator
J Cutan Pathol
. 2021 Jul 17.
doi: 10.1111/cup.14099. Online ahead of print.
A clinico-pathological description of COVID-19-induced chilblains (COVID toes) correlated with a published literature review
Athanassios Kolivras[SUP] 1 2 [/SUP], Curtis Thompson[SUP] 3 4 [/SUP], Ievgenia Pastushenko[SUP] 5 [/SUP], Marisa Mathieu[SUP] 1 [/SUP], Pascal Bruderer[SUP] 1 2 [/SUP], Marine de Vicq[SUP] 1 2 [/SUP], Francesco Feoli[SUP] 1 2 [/SUP], Saadia Harag[SUP] 1 2 [/SUP], Isabelle Meiers[SUP] 1 2 [/SUP], Catherine Olemans[SUP] 1 2 [/SUP], Ursula Sass[SUP] 1 2 [/SUP], Florence Dehavay[SUP] 1 [/SUP], Ali Fakih[SUP] 1 [/SUP], Xuan-Lan Lam-Hoai[SUP] 1 [/SUP], Alice Marneffe[SUP] 1 [/SUP], Laura Van De Borne[SUP] 1 [/SUP], Valerie Vandersleyen[SUP] 1 2 [/SUP], Bertrand Richert[SUP] 1 [/SUP]
Affiliations
Abstract
Background: The abundance of publications of COVID-19-induced chilblains has resulted in a confusing situation.
Methods: This is a prospective single-institution study from March 15 to May 13, 2020. Thirty-two patients received PCR nasopharyngeal swabs. Of these, 28 had a thoracic CT-Scan, 31 had blood and urine examinations, 24 had skin biopsies including immunohistochemical and direct immunofluorescence studies, and 4 patients had electron microscopy.
Results: COVID-19-induced chilblains are clinically and histopathologically identical to chilblains from other causes. Though intravascular thrombi are sometimes observed, no patient had a systemic coagulopathy or severe clinical course. The exhaustive clinical, radiological and laboratory work-up in this study ruled-out other primary and secondary causes. Electron microscopy revealed rare, probable viral particles whose core and spikes measured from 120-133 nm within endothelium and eccrine glands in 2 cases.
Conclusion: This study provides further clinicopathologic evidence of COVID-19 related chilblains. Negative PCR and antibody tests do not rule-out infection. Chilblains represents a good prognosis, occurring later in the disease course. No systemic coagulopathy was identified in any patient. Patients presenting with acral lesions should be isolated, and chilblains should be distinguished from thrombotic lesions (livedo racemosa, retiform purpura or ischemic acral necrosis). This article is protected by copyright. All rights reserved.
Keywords: COVID-19; COVID-toes; CT scan; chilblains; coagulation; coagulopathy; direct immunofluorescence study; electron microscopy; histopathology; hypercoagulable; immunohistochemistry; interferon; livedo racemosa; lupus erythematosus; paraviral, retiform purpura; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); thrombi.
. 2021 Jul 17.
doi: 10.1111/cup.14099. Online ahead of print.
A clinico-pathological description of COVID-19-induced chilblains (COVID toes) correlated with a published literature review
Athanassios Kolivras[SUP] 1 2 [/SUP], Curtis Thompson[SUP] 3 4 [/SUP], Ievgenia Pastushenko[SUP] 5 [/SUP], Marisa Mathieu[SUP] 1 [/SUP], Pascal Bruderer[SUP] 1 2 [/SUP], Marine de Vicq[SUP] 1 2 [/SUP], Francesco Feoli[SUP] 1 2 [/SUP], Saadia Harag[SUP] 1 2 [/SUP], Isabelle Meiers[SUP] 1 2 [/SUP], Catherine Olemans[SUP] 1 2 [/SUP], Ursula Sass[SUP] 1 2 [/SUP], Florence Dehavay[SUP] 1 [/SUP], Ali Fakih[SUP] 1 [/SUP], Xuan-Lan Lam-Hoai[SUP] 1 [/SUP], Alice Marneffe[SUP] 1 [/SUP], Laura Van De Borne[SUP] 1 [/SUP], Valerie Vandersleyen[SUP] 1 2 [/SUP], Bertrand Richert[SUP] 1 [/SUP]
Affiliations
- PMID: 34272741
- DOI: 10.1111/cup.14099
Abstract
Background: The abundance of publications of COVID-19-induced chilblains has resulted in a confusing situation.
Methods: This is a prospective single-institution study from March 15 to May 13, 2020. Thirty-two patients received PCR nasopharyngeal swabs. Of these, 28 had a thoracic CT-Scan, 31 had blood and urine examinations, 24 had skin biopsies including immunohistochemical and direct immunofluorescence studies, and 4 patients had electron microscopy.
Results: COVID-19-induced chilblains are clinically and histopathologically identical to chilblains from other causes. Though intravascular thrombi are sometimes observed, no patient had a systemic coagulopathy or severe clinical course. The exhaustive clinical, radiological and laboratory work-up in this study ruled-out other primary and secondary causes. Electron microscopy revealed rare, probable viral particles whose core and spikes measured from 120-133 nm within endothelium and eccrine glands in 2 cases.
Conclusion: This study provides further clinicopathologic evidence of COVID-19 related chilblains. Negative PCR and antibody tests do not rule-out infection. Chilblains represents a good prognosis, occurring later in the disease course. No systemic coagulopathy was identified in any patient. Patients presenting with acral lesions should be isolated, and chilblains should be distinguished from thrombotic lesions (livedo racemosa, retiform purpura or ischemic acral necrosis). This article is protected by copyright. All rights reserved.
Keywords: COVID-19; COVID-toes; CT scan; chilblains; coagulation; coagulopathy; direct immunofluorescence study; electron microscopy; histopathology; hypercoagulable; immunohistochemistry; interferon; livedo racemosa; lupus erythematosus; paraviral, retiform purpura; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); thrombi.