The Department of Pathology (Sohier, Laurent-Roussel), Assistance Publique-Hôpitaux de Paris, AP-HP Centre-Université de Paris, Paris, France.
Université de Paris, Paris, France (Sohier, Dupin, Aractingi).
Arch Pathol Lab Med. 2021 Feb 1;145(2):137-144. doi: 10.5858/arpa.2020-0613-SA.
CONTEXT.—: During the coronavirus disease 2019 pandemic, several studies have described a distinctive cutaneous manifestation with a clinical picture resembling chilblains or chilblain lupus in young patients.
OBJECTIVE.—: To report the histopathologic description of a series of chilblainlike lesions appearing in the context of the severe acute respiratory syndrome coronavirus 2 epidemic.
DESIGN.—: The study included 13 patients with cutaneous acral lesions resembling chilblains occurring in the setting of suspected severe acute respiratory syndrome coronavirus 2 infection with available skin biopsy.
RESULTS.—: Two main histopathologic patterns were observed: a chilblainlike histopathologic pattern (10 of 13 cases; 77%) and a thrombotic vasculopathy pattern (3 of 13 cases; 23%). The chilblainlike histopathologic pattern featured a superficial and deep perivascular infiltrate of lymphocytes of varying intensity. This infiltrate was sometimes peri-eccrine and alterations of eccrine glands were present in most cases. Vacuolar alteration of the basal layer of the epidermis was found in a majority of patients. Lichenoid interface dermatitis was rarely present. The thrombotic vasculopathy pattern featured an absent or mild inflammatory infiltrate, multiple intraluminal fibrin thrombi, and ischemic epidermal necrosis. In both patterns, no true vasculitis was observed. No patient tested positive for severe acute respiratory syndrome coronavirus 2 by polymerase chain reaction, possibly because these lesions may represent late cutaneous manifestations of the disease or are associated with an early effective immune response.
CONCLUSIONS.—: The relationship of chilblainlike lesions to severe acute respiratory syndrome coronavirus 2 requires further investigations. Histopathologic features mimic chilblains, chilblain lupus, and, less frequently, a thrombotic vasculopathy. Response to viral infection might trigger diverse mechanisms leading to the 2 histopathologic patterns described.
在 2019 年冠状病毒病大流行期间，有几项研究描述了一种独特的皮肤表现，其临床表现类似于年轻人的冻疮样疹或冻疮样狼疮。
报告一系列类似冻疮样病变的组织病理学描述，这些病变出现在严重急性呼吸综合征冠状病毒 2 流行的背景下。
本研究纳入了 13 例患有类似冻疮样肢端皮肤病变的患者，这些病变发生在疑似严重急性呼吸综合征冠状病毒 2 感染的情况下，并进行了皮肤活检。
观察到两种主要的组织病理学模式：冻疮样组织病理学模式（13 例中的 10 例；77%）和血栓性血管病变模式（13 例中的 3 例；23%）。冻疮样组织病理学模式表现为不同强度的浅层和深层血管周围淋巴细胞浸润。这种浸润有时是周围汗腺的，并且大多数情况下汗腺都有改变。大多数患者的表皮基底层有空泡改变。很少有苔藓样界面性皮炎。血栓性血管病变模式表现为无或轻度炎症浸润、多个管腔内纤维蛋白血栓和缺血性表皮坏死。在这两种模式中，均未观察到真正的血管炎。由于这些病变可能代表疾病的晚期皮肤表现或与早期有效的免疫反应有关，因此没有患者通过聚合酶链反应检测到严重急性呼吸综合征冠状病毒 2 呈阳性。
与严重急性呼吸综合征冠状病毒 2 相关的类似冻疮样病变需要进一步研究。组织病理学特征类似于冻疮、冻疮样狼疮，并且较少见的是血栓性血管病变。对病毒感染的反应可能触发导致描述的 2 种组织病理学模式的不同机制。
