Papular Purpuric Gloves and Socks Syndrome in a Patient with
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Papular purpuric gloves and socks syndrome is a pruritic dermatosis that is typically associated with Parvovirus B19 and other viral infections. Authors present a case of a patient with papular purpuric gloves and socks syndrome who was recently diagnosed with COVID-19. While numerous cutaneous manifestations of COVID-19 infection have been reported thus far, to knowledge, this dermatosis has not been reported.

A 62-year-old woman presented to the emergency department reporting several days of a pruritic rash that started on the dorsal hands and then appeared on the dorsal feet. She was afebrile with otherwise unremarkable vital signs and was discharged on triamcinolone 0.1% cream twice daily. Two days later the rash had not improved, so she called her primary care physician and was prescribed fluocinonide 0.05% ointment twice daily over the phone.

The next day, her pruritus improved, but her rash continued to spread to include her left thigh, which led the patient to seek further evaluation by a dermatologist. When the patient was evaluated for the first time in dermatology clinic, approximately 10 days after the rash first appeared, the rash had not resolved despite topical treatment. Further interview revealed that she had tested positive for COVID-19 infection as demonstrated by positive polymerase chain reaction 6 weeks before the rash appeared.

She reported that she had recovered from COVID-19 at home without need for supportive care. On exam, she had unremarkable vital signs, Fitzpatrick V skin type, and violaceous smooth papules coalescing into plaques on the dorsal hands, dorsal feet and to lesser extent on the left anterior thigh. Petechial macules on the fingertips and shins were also noted. She did not have involvement of mucosa, palms, or soles. A 3-millimeter punch biopsy obtained from a representative lesion on the left dorsal hand demonstrated focal epidermal spongiosis, papillary dermal edema with extravasated erythrocytes, and a lymphocytic perivascular infiltrate in the superficial dermis. These histologic findings supported the diagnosis of papular purpuric glove and socks syndrome. Additional pertinent workup included Parvovirus B19 serologies positive for IgG, but negative for IgM. Complete blood count with differential and comprehensive metabolic panel were unremarkable.

Since review of systems were not otherwise suggestive of another recent viral illness, no further viral workup was ordered. She did, however, have negative serologies for HIV and Hepatitis B/C two years prior to presentation. The patient was continued on fluocinonide 0.05% ointment until her follow-up with marked improvement in the pruritic eruption.