Departments of Dermatology, and.
Pathology, A.S.S.T. Cremona, Cremona, Italy.
Am J Dermatopathol. 2021 May 1;43(5):342-348. doi: 10.1097/DAD.0000000000001819.
The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly spreading throughout the world. The study describes 12 patients with SARS-CoV-2 pneumonia, who developed an acute erythematous rash with nonfollicular pinhead-sized pustules, without mucosal involvement. The clinical differential diagnosis was viral rash, acute generalized exanthematous pustulosis (AGEP), or multiform erythema. computed tomography with a diagnosis of interstitial pneumonia and a respiratory tract sample positive for SARS-CoV-2 in a reverse transcriptase polymerase chain reaction assay. Patients had signs of respiratory distress and were treated with hydroxychloroquine, darunavir, ritonavir, heparin, ceftriaxone, and azithromycin. Punch biopsies showed subcorneal pustules typical of AGEP. Dermal microvascular injury and thrombosis as described in skin damage by SARS-CoV-2 infection was not observed. The direct immunofluorescence for IgG, IgA, IgM, and C3 was negative in 8 patients investigated. A polymerase chain reaction for RNA SARS-CoV-2 performed on frozen skin was negative in 5 of 6 patients. Most of our patients were treated with systemic corticosteroids. After some days (4-10), the diffuse erythema and pustules had improved. AGEP is classified as a severe cutaneous adverse reaction, provoked by drugs and acute infections. Characteristically, removal of the offending agent leads to spontaneous resolution typically in less than 15 days. The recognition of AGEP is important, in order to avoid confusion with a systemic infection and consequently to avoid incorrect treatment. Cutaneous adverse reactions to drugs are common and are major health problems worldwide causing considerable costs for health care systems. We suggest that in the patients with AGEP during SARS-CoV-2 pneumonia, viral infection is a risk factor for developing drug reaction.
由严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 引起的 2019 年新型冠状病毒病 (COVID-19) 在全球迅速蔓延。本研究描述了 12 例 SARS-CoV-2 肺炎患者，他们出现了急性红斑性皮疹，伴有非滤泡性针状大小的脓疱，无黏膜受累。临床鉴别诊断为病毒性皮疹、急性全身性发疹性脓疱病 (AGEP) 或多形红斑。胸部计算机断层扫描显示间质性肺炎，逆转录聚合酶链反应检测呼吸道样本 SARS-CoV-2 阳性。患者有呼吸窘迫的迹象，并接受羟氯喹、达鲁那韦、利托那韦、肝素、头孢曲松和阿奇霉素治疗。皮肤活检显示典型的 AGEP 棘层下水疱。未观察到 SARS-CoV-2 感染皮肤损伤中描述的真皮微血管损伤和血栓形成。8 例接受检查的患者中，直接免疫荧光 IgG、IgA、IgM 和 C3 均为阴性。对 6 例患者中的 5 例进行的冷冻皮肤 SARS-CoV-2 聚合酶链反应为阴性。我们的大多数患者接受了全身皮质类固醇治疗。几天后 (4-10 天)，弥漫性红斑和脓疱有所改善。AGEP 被归类为药物和急性感染引起的严重皮肤不良反应。其特征为去除致病药物后，通常在 15 天内自发缓解。认识到 AGEP 很重要，以免与全身性感染混淆，并因此避免错误的治疗。药物引起的皮肤不良反应很常见，是全球范围内的主要健康问题，给医疗保健系统造成了相当大的费用。我们建议在 SARS-CoV-2 肺炎患者中，病毒感染是发生药物反应的危险因素。
