Images in Practice: Painful Cutaneous Vasculitis in a SARS-Cov-2 IgG-Positive Child
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CASE REPORT
Images in Practice: Painful Cutaneous Vasculitis in a SARS-Cov-2 IgG-Positive Child Alfonso Papa
. Anna M. Salzano . M. Teresa Di Dato .
Giustino Varrassi
Received: May 6, 2020 Ó The Author(s) 2020
Keywords: Child; Vasculitis
Coronavirus;
COVID-19;
INTRODUCTION The spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) during the ongoing coronavirus disease 2019 (COVID-19) pandemic has been particularly high in Italy. In Italy, as in the rest of the world, extremely rare cases of infection have been seen in the pediatric population. In a study carried out in China involving more than 44,000 cases of COVID-19, 0.9% of patients were between 0 and 10 years of age and 1.2% ranged in age from 10 to 19 years [1]. The absence of evident symptoms in children has reduced the need for nasopharyngeal and oropharyngeal swab screening in this age group [2], with the result that little information is currently available on this segment of the population. During the pandemic period in Italy, we observed more than ten pediatric Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12295805. A. Papa (&) A. M. Salzano M. T. Di Dato Pain Department, Monaldi Hospital, AO Ospedali dei Colli, Naples, Italy e-mail: [email protected] G. Varrassi Paolo Procacci Foundation, Via Tacito 7, 00193 Rome, Italy
patients who tested IgG positive for Sars-CoV-2 with painful vasculitic skin lesions on the feet that required modest pain relief therapy. Here, we describe the case history of one of these patients and present pictures of her condition.
CASE: 11-YEAR-OLD GIRL At the first observation, the patient had erythematous chilblain-like skin lesions on her feet and several ulcerative lesions with dyschromia of the nails (Fig. 1a); the erythematous areas did not disappear with finger pressure. In the previous 6 weeks she had not shown fever, cough, malaise or asthenia. Her medical history was negative for vascular and/or inflammatory conditions. She reported mild to moderate pain and itching. All blood tests were negative (complete blood count, ESR, PCR analysis, D-dimer, creatinine, AST, ALT, C3, C4, IL-6 and 25-hydroxyvitamin D). No Sars-CoV-2 virus was detected on the nose and oropharyngeal swab, while serologic testing for Sars-CoV-2 antibodies revealed Sars-CoV-2 IgG at 5.2 AU/ml (normal range [ 1 AU/ml) and Sars-CoV-2 IgM at 0.8 AU/ml (normal range [ 1 AU/ml). The pain measured using the Oucher scale, with the results indicating a score of 2 (range 0–5). The patients was immediately treated with paracetamol 750 mg 4 times/day. Some of these lesions became purulent in the following days
Pain Ther
Fig. 1 Vasculitic skin lesions on the feet of an 11-year-old girl. a Painful skin lesions at first observation, b skins lesion after 7 days, c skin lesions after 10 days, d complete resolution of skin lesions after 15 days of treatment
and was treated with Mupirocin 2% Ointment 3 time per day. After 7 days the analgesic therapy was discontinued (Fig. 1b, c)
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