Torrelo Antonio, Andina David, Santonja Carlos, Noguera-Morel Lucero, Bascuas-Arribas Marta, Gaitero-Tristán Jara, Alonso-Cadenas José Antonio, Escalada-Pellitero Silvia, Hernández-Martín Ángela, de la Torre-Espi Mercedes, Colmenero Isabel
Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Pediatr Dermatol. 2020 May;37(3):442-446. doi: 10.1111/pde.14246.
During examination of cases of chilblains in children and adolescents, we identified four patients who also showed skin lesions similar to erythema multiforme (EM). They had no other known triggers for EM. One of them had a positive PCR for SARS-CoV-2, while the other three were negative. Skin biopsies from two patients showed features not typical of EM, such as deep perivascular and perieccrine infiltrate and absence of necrosis of keratinocytes. Immunohistochemistry for SARS-CoV/SARS-CoV-2 spike protein showed granular positivity in endothelial cells and epithelial cells of eccrine glands in both biopsies. All patients had an excellent outcome, and had minimal or no systemic symptoms. The coincidence of EM, a condition commonly related to viruses, and chilblains in the setting of COVID-19, and the positivity for SARS-CoV/SARS-CoV-2 spike protein by immunohistochemistry strongly suggest a link between EM-like lesions and SARS-CoV-2.
在对儿童和青少年冻疮病例进行检查时，我们发现了四名患者，他们还表现出类似于多形红斑（EM）的皮肤病变。他们没有其他已知的引发EM的诱因。其中一名患者的新型冠状病毒（SARS-CoV-2）聚合酶链反应（PCR）检测呈阳性，而其他三名患者为阴性。两名患者的皮肤活检显示出非典型的EM特征，如深层血管周围和汗腺周围浸润以及角质形成细胞无坏死。针对SARS-CoV/SARS-CoV-2刺突蛋白的免疫组织化学显示，在两份活检样本中，内皮细胞和汗腺上皮细胞呈颗粒状阳性。所有患者预后良好，全身症状轻微或无全身症状。EM（一种通常与病毒相关的病症）与COVID-19背景下的冻疮同时出现，以及免疫组织化学检测显示SARS-CoV/SARS-CoV-2刺突蛋白呈阳性，强烈提示了类似EM的病变与SARS-CoV-2之间存在联系。
