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新冠长期患者神经性皮肤疼痛的病理元凶:病例系列

The Pathological Culprit of Neuropathic Skin Pain in Long COVID-19 Patients: A Case Series.

作者信息

Grieco Teresa, Gomes Vito, Rossi Alfredo, Cantisani Carmen, Greco Maria Elisabetta, Rossi Giovanni, Sernicola Alvise, Pellacani Giovanni

机构信息

Department of Clinical Internal Anesthesiological and Cardiovascular Sciences, "Sapienza" University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.

Department of Anatomy and Pathology, Ospedale San Filippo Neri, Via G. Martinotti 20, 00183 Rome, Italy.

出版信息

J Clin Med. 2022 Jul 31;11(15):4474. doi: 10.3390/jcm11154474.

Abstract

Cutaneous neurosensory symptoms have become increasingly reported findings in COVID-19; however, these virus-related manifestations are largely overlooked, and their pathology is poorly understood. Moreover, alterations of skin sensibility currently recognize no clear histopathology substrate. The purpose of this study was to provide pathology evidence of neurosensory skin system involvement in COVID-19 patients complaining of subjective neurological symptoms affecting the skin. Out of 142 patients, six long COVID-19 cases complaining of cutaneous subjective neurological symptoms assessed on an NTSS-6 questionnaire underwent histopathological and immunohistochemical analyses of skin areas affected by paroxysmal diffuse burning and itching sensations. Two patients also performed electroneurography examination. The histology investigation showed hypertrophic glomus vascular bodies with hypertrophic S100+ perineural sheath cells and adjacent hypertrophy of the nerve branches associated with increased basophil polysaccharide matrix. Electroneurography revealed disturbances of A-delta and C dermal neuronal fibers. The main limitation of this study consisted of a limited number of skin biopsy samples, requiring further investigation. Histopathology findings are consistent with hypertrophy of nerve endings, suggesting a condition such as "dermal hyperneury", a recently reported small nerve hypertrophy condition affecting sensory C fibers. Such a neuropathic basis could explain dysesthesia experienced by the patients, as previously described in postherpetic neuralgia.

摘要

皮肤神经感觉症状在新冠病毒病(COVID-19)中越来越多地被报道;然而,这些与病毒相关的表现很大程度上被忽视了,其病理机制也知之甚少。此外,目前皮肤感觉的改变尚未发现明确的组织病理学基础。本研究的目的是为新冠病毒病患者中涉及皮肤主观神经症状的神经感觉皮肤系统受累提供病理学证据。在142名患者中,6例长期新冠病毒病患者抱怨有皮肤主观神经症状,通过NTSS-6问卷进行评估,对受阵发性弥漫性烧灼感和瘙痒感影响的皮肤区域进行了组织病理学和免疫组织化学分析。2名患者还进行了神经电生理学检查。组织学研究显示球血管体肥大,伴有S100+神经周鞘细胞肥大,以及相邻神经分支肥大,同时嗜碱性多糖基质增加。神经电生理学显示A-δ和C皮神经元纤维功能障碍。本研究的主要局限性在于皮肤活检样本数量有限,需要进一步研究。组织病理学结果与神经末梢肥大一致,提示一种如“皮肤神经增生”的情况,这是最近报道的一种影响感觉C纤维的小神经肥大情况。这种神经病变基础可以解释患者所经历的感觉异常,如先前在带状疱疹后神经痛中所描述的那样。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/71b9/9369885/3ea91a84ca22/jcm-11-04474-g001.jpg

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