Mazzitelli Maria, Dastoli Stefano, Mignogna Chiara, Bennardo Luigi, Lio Elena, Pelle Maria Chiara, Trecarichi Enrico Maria, Pereira Branca Isabel, Nisticò Steven Paul, Torti Carlo
Department of Medical and Surgical Sciences, Infectious and Tropical Disease Unit, Magna Graecia University, Catanzaro 88100, Italy.
Department of Health Sciences, Magna Graecia Università of Catanzaro, Catanzaro 88100, Italy.
World J Clin Cases. 2021 Jul 16;9(20):5744-5751. doi: 10.12998/wjcc.v9.i20.5744.
Several cutaneous manifestations such as urticarial rash, erythematous patches and chilblain-like lesions have been described in young adults with coronavirus disease 2019 (COVID-19) and are present in up to 20% patients, but few reports exist describing histopathological and immunophenotypic characteristics of dermatological lesions in older patients. Our aim was to characterize skin lesions in elderly patients during late stages of COVID-19 from clinical, histological and immunophenotypic perspectives.
Three patients, admitted for COVID-19, and who developed cutaneous manifestations underwent skin biopsies. Immunophenotypic analysis for CD20, CD3, CD4 and CD8 was performed on skin biopsies to assess immune cell infiltrates. CD1a was used as a marker of Langerhans cells, and CD31 as a marker of endothelial cells. In the three study patients, cutaneous manifestations were evident in the late-stage of COVID-19 (mean time from the first positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swab to rash onset was 35 d). Skin biopsies showed a similar pattern of T lymphocyte infiltration in all patients. Indeed, a chronic dermatitis with perivascular lymphocytic infiltrate was observed with predominance of CD3+ T-cell (CD3+).
Our study confirms previous reports. Histological and immunophenotypic patterns in our patients confirm results described in the two previous reported experiences. This pattern is similar to what is found in some lympho-proliferative disorders. Therefore, since these findings are non-specific, SARS-CoV-2 infection should be suspected.
在患有2019冠状病毒病（COVID-19）的年轻人中已描述了几种皮肤表现，如荨麻疹样皮疹、红斑和冻疮样病变，高达20%的患者出现这些症状，但很少有报告描述老年患者皮肤病变的组织病理学和免疫表型特征。我们的目的是从临床、组织学和免疫表型角度对COVID-19晚期老年患者的皮肤病变进行特征描述。
三名因COVID-19入院并出现皮肤表现的患者接受了皮肤活检。对皮肤活检组织进行CD20、CD3、CD4和CD8的免疫表型分析，以评估免疫细胞浸润情况。CD1a用作朗格汉斯细胞的标志物，CD31用作内皮细胞的标志物。在这三名研究患者中，皮肤表现在COVID-19晚期明显（从首次严重急性呼吸综合征冠状病毒2（SARS-CoV-2）拭子检测呈阳性到皮疹出现的平均时间为35天）。所有患者的皮肤活检均显示出类似的T淋巴细胞浸润模式。实际上，观察到一种伴有血管周围淋巴细胞浸润的慢性皮炎，以CD3 + T细胞（CD3 +）为主。
我们的研究证实了先前的报告。我们患者的组织学和免疫表型模式证实了之前两项报告中的结果。这种模式与某些淋巴增殖性疾病中发现的模式相似。因此，由于这些发现不具有特异性，应怀疑感染了SARS-CoV-2。
