Marchetti Federico, Guiducci Claudia, Bigucci Barbara, Iacono Alessandra, Calderoni Ombretta, Sorci Maria Rita, Sparacino Monica, Semprini Simona, Vergine Gianluca
UOC di Pediatria e Neonatologia, Ospedale di Ravenna.
UOC di Pediatria e Neonatologia, Ospedale di Ravenna - Scuola di Specializzazione in Pediatria, Università di Ferrara.
Recenti Prog Med. 2020 Sep;111(9):480-486. doi: 10.1701/3421.34060.
At the end of March 2020, just over a month after the first ascertained case of CoViD-19 infection in Italy, the first reports of acute lesions of acro-ischemia appeared, especially in pre-adolescents and adolescents. These manifestations have been called in the course of these months in various ways, from "acro-ischemia acuta", "erythema pernio", "chilblains", up to characterize them more recently as "CoViD Toes". Clinical manifestations do not usually associate with other typical symptoms of Covid-19 and do not find a classical and defined serological antibody response (IgG and IgM). From a clinical point of view it is a localized and self-resolving problem of an interesting and relatively new pathogenetic model of disease in relation to a viral agent. Future studies must make us understand if there is in this specific condition a low viral load is not detectable by current methods and if this explains the inability to produce an adequate immune response for CoViD-19. It is important to determine whether the interferon immune response in some subjects can be the cause of both the low viremia and the endothelial damage so localized in the acral-site, as happens in other models of diseases (chilblain-lupus like). On the contrary, some authors believe that the acral lesions are attributable to chilblains caused by a series of favourable environmental conditions due to forced enclosure. We report the descriptive experience of 14 cases of acro-ischemia in children and adolescents observed in the territorial area of Ravenna and Rimini. The cases were subjected to the nasopharyngeal swab and to the search for antibodies with ELISA method for CoViD-19 both with negative results.
2020年3月底，在意大利确诊首例新型冠状病毒肺炎（COVID-19）感染病例仅一个多月后，就首次出现了肢端缺血急性病变的报告，尤其是在青春期前儿童和青少年中。在这几个月里，这些表现被用各种方式称呼，从“急性肢端缺血”“冻疮红斑”“冻疮”，到最近将它们描述为“COVID脚趾”。临床表现通常与COVID-19的其他典型症状无关，也未发现典型且明确的血清学抗体反应（IgG和IgM）。从临床角度来看，这是一个与病毒病原体相关的有趣且相对较新的发病机制模型中局部性且可自愈的问题。未来的研究必须让我们明白，在这种特定情况下，是否存在当前方法无法检测到的低病毒载量，以及这是否解释了无法产生针对COVID-19的充分免疫反应的原因。确定在某些受试者中干扰素免疫反应是否可能是低病毒血症和如此局限于肢端部位的内皮损伤的原因很重要，就像在其他疾病模型（冻疮样狼疮）中发生的那样。相反，一些作者认为肢端病变归因于因强制封闭导致的一系列有利环境条件引起的冻疮。我们报告了在拉韦纳和里米尼地区观察到的14例儿童和青少年肢端缺血的描述性经验。这些病例进行了鼻咽拭子检测，并采用ELISA方法检测COVID-19抗体，结果均为阴性。
