Cutaneous manifestations of COVID-19: report of three cases
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CASE SERIES
Cutaneous manifestations of COVID‑19: report of three cases Imen Chaabane1,2 · Manel Loukil1,3 · Raja Amri1,2 · Imen Badri1,3 · Hajer Baha1,2 · Manel Lajmi1,2 · Khaled Bouzaidi1,4 · Hedia Ghrairi1,3 Received: 24 May 2020 / Revised: 1 July 2020 / Accepted: 31 July 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Coronavirus disease 2019 (COVID-19) shows rapid spread around the world. Its classic presentation is a respiratory illness. However, cutaneous manifestations have rarely been described as the first clinical manifestation in patients with this infection. The aim of this article is to describe cutaneous manifestations in patients with COVID-19 through three case reports. Keywords COVID-19 · Cutaneous manifestations · COVID-19 symptoms
Introduction
Case 1
Coronavirus disease 2019 (COVID-19), first detected in Wuhan City on December 31, 2019, has emerged as a public health emergency [1]. In Tunisia, the epidemic phase of COVID-19 began in March 2020 and resulted in implementing special emergency measures. By May 2, 2020, 1013 confirmed cases and 42 deaths have been caused by COVID-19. The most common symptoms of COVID-19 are fever, dry cough, fatigue, myalgia and dyspnea [1–3]. However, other symptoms have been reported, including gastrointestinal and neurological manifestations. Cutaneous lesions were not recognized at the early stages of the pandemic, but have received much recent attention in scientific journals [4–8]. This article describes three cases of COVID-19 revealed by cutaneous manifestations.
A 20-year-old woman, belonging to medical staff, presented cervical, axillary and inguinal nodes. Four days later, she developed a fever and pruritic maculopapular lesions (Fig. 1) and urticaria (Fig. 2) on the trunk. Subsequently, the rashes spread to form target lesions (erythema multiform like), painful eroded and ulcerated papules, small plaques on the upper limbs (Fig. 3a, b) and purple to blue lesions in the thighs (Fig. 4). Laboratory tests revealed a lymphopenia. The naso-pharyngeal swab tested for SARSCoV-2 RNA amplification was positive. In the following days, she developed dry cough. The oxygen saturation was 98%. The chest CT scan was normal. She remained hemodynamically stable, and she had not any treatment. The patient cured from COVID-19 about one month after the start of the clinical picture; she kept post-inflammatory hyperpigmentation on the thighs (Fig. 5).
Case 2 * Imen Chaabane [email protected] 1
Faculty of Medicine of Tunis, University Tunis El Manar, 1007 Tunis, Tunisia
2
Department of Internal Medicine, MT Maamouri Hospital, 8050 Nabeul, Tunisia
3
Department of Pulmonology, MT Maamouri Hospital, 8050 Nabeul, Tunisia
4
Department of Radiology, MT Maamouri Hospital, 8050 Nabeul, Tunisia
A 35-year-old woman, belonging to medical staff, presented burning retrosternal discomfort and a dry cough without fever 7 days after a contact with COVID-19 patient. Three days later, she developed itchy rash on upper chest (Fig. 6) a
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