Silent COVID-19: What your skin can reveal!
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Clinical manifestations of COVID-19 are rare or absent in children and adolescents; hence, early clinical detection is fundamental to prevent further spreading. This report presents three young patients presenting with chilblain-like lesions who were diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Two of them were asymptomatic and potentially contagious. Skin lesions, such as erythematous rashes, urticaria, and chicken pox-like vesicles, were reported in 18 of 88 patients with COVID-19 in a previous study.

Patient 1: A 14-year-old boy who presented with erythematous-violaceous lesions involving the dorsum of all digits of both feet. After 7 days, a few red macules and papules appeared on the lateral and plantar aspect of both feet and a small ulcer developed on the fifth digit of the left foot. Because a family member had tested positive for SARS-CoV-2, the patient underwent nasopharyngeal swab and was found positive for SARS-CoV-2 on RT-PCR. The lesions disappeared in the following 7 days.

Patient 2: A 14-year-old boy with no known contact with COVID-19 cases and had been asymptomatic since the beginning of the skin disease. Manifestations consisted of small erythematous-violaceous lesions on the dorsum of almost all digits of the feet, some of which were characterised by necrotic aspects with blackish crusts (appendix). The lesions lasted 20 days, with complete healing. Nasopharyngeal swab was positive for SARS-CoV-2.

Patient 3: An 18-year-old boy whose grandfather had COVID-19 pneumonia. After 2 days with fever (38.5°C), the boy reported the appearance of chilblain-like lesions involving the distal part of all digits of the feet (appendix). Skin manifestations remained unchanged for 10 days, suddenly disappearing without treatment. Nasopharyngeal swab taken 4 days after the skin manifestations appeared was positive.

During this time, children and adolescents with chilblain-like lesions who are otherwise asymptomatic should undergo SARS-CoV-2 testing, which could help early detection of silent carriers.

Source: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30402-3/fulltext
Dr. R●●●t K●●●r A●●●a and 15 others like this7 shares
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