Acral lesions in a pediatric population during the COVID-19 pandemic: a case series of 36 patients from a single hospita
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BRIEF REPORT
Acral lesions in a pediatric population during the COVID‑19 pandemic: a case series of 36 patients from a single hospital in Spain Pau Rosés‑Gibert1 · Javier Gimeno Castillo1 · Amaia Saenz Aguirre1 · Francisco Javier De la Torre Gomar1 · Lucía Carnero González1 · Zuriñe Martinez de Lagrán Alvarez de Arcaya1 · Ricardo Gonzalez‑Perez1 Received: 12 June 2020 / Accepted: 24 August 2020 © Children’s Hospital, Zhejiang University School of Medicine 2020
Abstract Background To describe the cutaneous acral findings in a pediatric population noticed during this pandemic. Methods A retrospective descriptive study was performed collecting data on 36 patients under 14 years old, presenting suspicious acral skin manifestations for coronavirus disease 2019 (COVID-19). Results Patients were mostly male (63.8%). The mean age was 11.11 years. 66.67% of patients showed erythematous papules, and 44.44% purpuric macules. Feet were affected in 97.22% of patients and hands in 5.55%. Lesions were asymptomatic in 50% of patients. 30.55% of patients showed extracutaneous findings, preceding skin lesions in 12.62 days. Seven patients underwent specific severe acute coronavirus 2 (SARS-CoV-2) testing; all of these patients tested negative. Conclusions The association between these symptoms and SARS-CoV-2 remains unclear. We recommend using these manifestations as a sign of SARS-CoV-2 infection in children. This could lead to the examination of asymptomatic and mildly symptomatic children so that contagions may be avoided. Keywords Acral lesions · Acute acro-ischemia · Chilblain-like · COVID-19
Introduction In December 2019, pneumonia cases caused by a novel coronavirus known as severe acute coronavirus 2 (SARS-CoV-2) were described initially. This disease then was named as coronavirus disease 2019 (COVID-19) [1]. COVID-19 spread quickly throughout the globe, leading to a pandemic [2], announced by March 11, 2020, by the World Health Organization. To date (August 10, 2020), Spain is the 11th most affected country in the world with 314,362 cases and 28,503 deaths reported. We have thoroughly reviewed the literature concerning cutaneous manifestations of COVID-19. The most common cutaneous manifestations reported are an erythematous, vesicular or urticarial rash [3–6]. There have also been described cases presenting acral erythematous or purpuric lesions [7–13], which may also be common. There are few * Pau Rosés‑Gibert [email protected] 1
Araba University Hospital, Francisco Leandro de Viana Street, 01009 Vitoria, Spain
reports of these manifestations in the pediatric population [9, 12, 13]. At Araba University Hospital, in Vitoria-Gasteiz (North of Spain), the number of consultations for acral lesions in children greatly surpassed the usual, prompting further exploration.
Methods Study design We performed a retrospective descriptive study of our pediatric population (considered under 14 years old in Spain). 36 children from our area (Álava, Spain) presented to our institution with acral skin symptoms consiste
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