A A Case of Flexural Exanthema as a Presenting Sign for COVID-19

• Main Authors: Raquel Oliveira, Margarida Gonçalo, Carlos Faria, David Donaire, Benilde Barbosa, José Carlos Cardoso, Maria José Julião, José Moura, Armando Carvalho
• Format: Article
• Language: English
• Published: Sociedade Portuguesa de Dermatologia e Venereologia 2020-09-01
• Series: Revista da Sociedade Portuguesa de Dermatologia e Venereologia
• Subjects: Coronavirus Infections; COVID-19; Exanthema; SARS-CoV-2
• Online Access: https://revista.spdv.com.pt/index.php/spdv/article/view/1248
• ISSN: 2182-2395; 2182-2409

We report a case of a 84-year-old male hospitalized for bacterial pneumonia who, during hospitalization, developed a flexural exanthema in parallel with a positive swab for SARS-CoV-2. Supportive therapy was instituted, the rash disappeared in 7 days and the patient fully recovered. At the same time, two other cases of SARS-CoV-2 infection occurred in the same ward. Histopathology and immunohistochemistry of a skin biopsy showed a scarce predominantly perivascular lymphocytic infiltration in the upper dermis, predominantly by CD4+ T cells, a slight epidermotropism, spongiosis and focal parakeratosis, compatible with a viral exanthema or a maculopapular drug eruption. Patch testing with possible culprit drugs were negative. We seek to add value in understanding all the manifestations of SARS-CoV-2 infection and to draw attention to the importance of early identification of skin manifestations in association with COVID-19.