#JAMACaseChallenge: Digitate Papulosquamous Eruption Associa
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An elderly patient with type 2 diabetes, hypertension, peripheral artery disease, and chronic renal failure was admitted to the intensive care unit for acute respiratory distress. Computed tomography of the chest showed bilateral peripheral ground-glass opacities with subpleural condensation. A nasopharyngeal SARS-CoV-2 reverse transcriptase–polymerase chain reaction (RT-PCR) confirmed the diagnosis of COVID-19.

One day after hospital admission, the patient developed a squamous and erythematous periumbilical patch with rapid progression of other similar digitate scaly thin plaques on the lateral side of the trunk and thighs. Some lesions on the upper arms, shoulders, and back were papular. This digitate papulosquamous eruption was clinically reminiscent of pityriasis rosea. A skin biopsy of the left shoulder revealed foci of spongiosis with focal parakeratosis in the epidermis and a few rounded spongiotic vesicles containing aggregates of lymphocytes and Langerhans cells. A moderate lymphohistiocytic infiltrate was present in the superficial dermis and was associated with papillary dermal edema.

RT-PCR on a fresh skin biopsy specimen was performed, and the results were negative for SARS-CoV-2. Results of Epstein-Barr virus (EBV) PCR results were positive, with a viral load of 4.6 log10 copies/mL reflecting EBV replication. Serologic markers indicated reactivation and ruled out acute mononucleosis. The cutaneous rash resolved spontaneously within a week. The patient died of COVID-19–related illness.
This observation can be included in the complex category of paraviral dermatoses. Owing to the current COVID-19 pandemic, clinicians should be aware of this new potential association.

Source: https://jamanetwork.com/journals/jamadermatology/fullarticle/2765613