Drenovska Kossara, Shahid Martin, Mateeva Valeria, Vassileva Snejina
Department of Dermatology and Venereology, Medical University-Sofia, Sofia, Bulgaria.
Front Med (Lausanne). 2022 Feb 14;9:815743. doi: 10.3389/fmed.2022.815743. eCollection 2022.
The current COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had an important impact on dermatology practice, posing diagnostic and therapeutic challenges especially in patients with inflammatory and autoimmune skin disorders. Disease-specific and nonspecific cutaneous manifestations have been increasingly reported in the spectrum of COVID-19 but the influence of the infection on pre-existing dermatologic diseases has not been clearly defined. There has been a debate in the literature as to whether patients suffering from autoimmune dermatoses, including cutaneous lupus erythematosus (CLE), are at increased risk of SARS-CoV-2 infection, as well as if they experience worsening of their lupus erythematosus (LE)-related clinical symptoms. This article reports on a case of Rowell syndrome occurring after COVID-19 in a 67-year old woman with pre-existing chronic CLE manifesting with few discoid lesions on the face, scalp, and upper chest, successfully controlled with topical corticosteroids and photoprotection. Erythema multiforme (EM)-like eruption developed approximately two weeks after the SARS-CoV-2 infection, the latter being confirmed by positive nasopharyngeal swab and successfully treated with systemic antibiotics and antiaggregants. Diffuse hair loss and patches of cicatricial alopecia were also present upon scalp examination. Laboratory workup, including routine tests, histologic, immunofluorescent, and serologic investigations, was supportive to the diagnosis. Administration of topical and systemic corticosteroids along with peroral hydroxychloroquine resulted in the progressive improvement of the cutaneous lesions. Rowell syndrome is a rare entity in the spectrum of LE, characterized by EM-like lesions, photosensitivity, and positive antinuclear and anti-Ro antibodies, that is currently considered to be a variant of subacute CLE (SCLE). Several cases of SCLE have been described in association with medications, including anti-SARS-CoV-2 vaccines but only a few reports incriminate the infection itself as a potential exacerbating factor. Based on the clinical course of the disease, we suggest that the observed Rowell syndrome-like flare of CLE was related to the COVID-19 infection in this patient.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的当前新冠疫情对皮肤科实践产生了重要影响，尤其给患有炎症性和自身免疫性皮肤病的患者带来了诊断和治疗方面的挑战。新冠疫情中，越来越多的病例报告了疾病特异性和非特异性的皮肤表现，但感染对既往存在的皮肤病的影响尚未明确界定。文献中存在争议的是，患有自身免疫性皮肤病（包括皮肤红斑狼疮（CLE））的患者感染SARS-CoV-2的风险是否增加，以及他们的狼疮（LE）相关临床症状是否会加重。本文报告了一例67岁女性在感染新冠后出现罗威尔综合征的病例，该女性既往患有慢性CLE，面部、头皮和上胸部有少量盘状皮损，通过外用糖皮质激素和光防护措施病情得到成功控制。在SARS-CoV-2感染约两周后出现了多形红斑（EM）样皮疹，经鼻咽拭子检测呈阳性确诊感染，随后通过全身使用抗生素和抗凝剂成功治疗。头皮检查还发现弥漫性脱发和瘢痕性脱发斑。包括常规检查、组织学、免疫荧光和血清学检查在内的实验室检查结果支持该诊断。外用和全身使用糖皮质激素以及口服羟氯喹啉使皮肤病变逐渐改善。罗威尔综合征是LE谱系中的一种罕见疾病，其特征为EM样皮损、光敏性以及抗核抗体和抗Ro抗体阳性，目前被认为是亚急性CLE（SCLE）的一种变体。已有几例SCLE病例被描述与药物有关，包括抗SARS-CoV-2疫苗，但只有少数报告将感染本身认定为潜在的加重因素。基于该疾病的临床病程，我们认为该患者观察到的CLE类似罗威尔综合征的发作与新冠感染有关。
