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Maculopapular rash following off-label use: case report A 35-year-old man developed maculopapular rash during off-label treatment with lopinavir/ritonavir for COVID-19. The man, who was suspected to have SARS-CoV-2 infection, was admitted to a hospital in Poland. He was asymptomatic, and he neither had a history of travel abroad nor exposure to patients infected and suspected of COVID-19 infection. In the week prior to hospitalisation, he was diagnosed with optic neuritis, for which he had been receiving methylprednisolone and was treated on an out-patient basis. During a follow-up examination, he tested positive for COVID-19, and SARS-CoV-2 viral nucleic acid detection using real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay confirmed the diagnosis of COVID-19. He was admitted to the isolation unit, and started receiving off label treatment with oral lopinavir/ritonavir 400/100 twice daily. Optic neuritis was considered as an unspecific symptom of the COVID-19. Later, RT-PCR tests showed negative results twice for the covid-19 infection, and he was considered to have recovered from the COVID-19 infection. Following 10 days of initiation of lopinavir/ritonavir therapy, he developed an itchy, maculopapular rash, while he was still hospitalised. Initially, the lesions developed on the skin of the trunk, and the lesions spread to the upper extremities after 24h. Non-tender, erythematous macules and papules, which were bilateral and symmetrical in distribution and localised on the skin of the neck, arms and trunk, were observed on dermatological examination. He did not have a history of contact dermatitis, adverse drug reactions and any other hypersensitivity reactions. A diagnosis of maculopapular rash secondary to off-label lopinavir/ritonavir therapy was made, and the COVID-19 was suspected to be a cofactor for the development of maculopapular rash. The man had been receiving methylprednisolone, and therefore, the dose of systemic corticosteroids was increased. Also, he started receiving unspecified topical corticosteroids and systemic antihistamines. During a 10-day follow-up examination, skin lesions had disappeared almost completely. He had been undergoing ophthalmological care, and improvement of vision was noted. Mazan P, et al. Maculopapular rash in COVID-19 patient treated with lopinavir/ritonavir. Postepy Dermatologii i Alergologii 37: 435-437, No. 3, 2020. Available from: URL: 803504153 http://doi.org/10.5114/ada.2020.95029

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Reactions 3 Oct 2020 No. 1824