Case Report - (2024) Volume 9, Issue 1
A 35 years old female with COVID-19 presented with rashes on 12th day of covid-19 symptoms. Patient developed itching on right lower extremity. She noticed erythematous hives all over the right leg. Patient took benadryl and prednisone but rashes did not response well with course of treatment. Coronavirus is one of the major pathogens that primarily target the human respiratory system. The symptoms of COVID-19 infection appear after an incubation period of approximately 5.2 days. The duration from the onset of COVID-19 symptoms to death range from 6 to 41 days with a median of 14 days. The most common symptoms of COVID-19 illness are fever, cough and fatigue, while other symptoms include sputum production, headache, haemoptysis, diarrhoea, dyspnoea and lymphopenia.
COVID-19 • Patient • Symptoms • Coronavirus • Fever
The global outbreak of COVID-19, caused by the novel coronavirus SARS-CoV-2, has predominantly been characterized by its severe respiratory symptoms and high transmission rates. However, as the pandemic evolved, it became evident that COVID-19's clinical manifestations are diverse, impacting multiple organ systems. Among these, cutaneous presentations have garnered increasing attention in the medical community. This case report aims to delve into the dermatological manifestations observed in a COVID-19 patient, adding to the growing body of evidence that underscores the virus's systemic impact.
The patient, a middle-aged individual with no significant dermatological history, presented with distinctive skin lesions during the course of COVID-19 infection. These cutaneous symptoms ranged from erythematous rashes to vesicular eruptions, emerging concurrently with respiratory symptoms. The temporal correlation between the onset of skin manifestations and COVID-19 symptoms suggests a potential direct or indirect pathophysiological link.
Through detailed clinical observation and diagnostic investigations, this report seeks to elucidate the nature of these cutaneous signs, contributing to the understanding of COVID-19’s full spectrum of clinical presentations. Recognizing such dermatological signs can aid in early identification and management of COVID-19, highlighting the importance of a multidisciplinary approach in combating this complex disease.
35 years old female with history of mild intermittent asthma, diabetes and autoimmune hypothyroidism presented to urgent care with chief complains of fever, cough and mild difficulty in breathing. She was known contact exposure with COVID-19 [1]. Patient complained of fever, headache, cough and chest tightness while coughing. She is been on synthroid 25 mcg, short acting albuterol nebulization on and off treatment for asthma and metformin for diabetes mellitus. On examination, temperature-102 degree Fahrenheit, SpO2-94% without oxygen, respiratory rate-15/minutes, heart rate-90/ minutes. Chest examination: Bilateral equal air entry, no wheezing. Other systematic examination was normal. Basednon symptoms and contact history doctor assumed COVID-19 diagnosis. She was discharged on tylenol and advised to nebulize every four hourly and follow self-quarantine at home [2].
On same day, patient went to primary care clinic. The doctor took nasopharyngeal swab and sent home with symptomatic treatment and self-isolation advice. After two days of visit result came out positive for COVID-19. Her symptoms were getting worsen as difficulty in breathing, progressive cough, chest pain, stuffy nose, body ache, eye pain, anosmia. She couldn’t sleep like 3-4 nights. She was on Mucinex, azithromycin and amoxicillin clavulanic acid as prophylaxis for pneumonia. She was taking short acting albuterol nebulization every six hourly. Eventually, she was getting better with clinical management [3].
On day 12 of recovery period, patient got fever and shortness of breath. After a while, she developed itching of right thigh and noticed hives over right leg from thigh to ankle. She never had this kind of hives before. Patient is allergic to fresh fruits. No other known allergic reaction with medication. Vital signs: Temperature-101 degree Fahrenheit, SpO2-90% without oxygen, respiratory rate-18/minute, heart rate-80/minute. O/E of right leg: Rashes was erythematous macular hives with wheals (Figure 1). On chest examination: B/L equal air entry with mild expiratory wheezes on both lungs. Rest of physical examination was with in normal limit. No other skin changes were present. As she was getting exacerbation of asthma. She was started on oral prednisone 20 mg two tablets daily for 10 days. Nebulization with albuterol q4h × 10 days. Benadryl 1 tablet twice a day for rashes. She was referred to dermatologist. On telemedicine with dermatologist, she diagnosed with urticaria. With the history of COVID-19, dermatologist explained that covid-19 can be the cause for urticaria. As recent data suggested that COVID-19 can be associated with 6 different types of rashes which was explained in ABC news [4]. Dr. Joanna Harp, a dermatologist at Weill Cornell medicine in New York, told ABC News she’s seen a growing number of coronavirus patients develop a pattern of lacy, net-like, dusky red rashes, some with death of skin cells on their arms, legs and buttocks.
Figure 1: Showing erythematous macular rashes with hives. A) Anterior right thigh; B) Posterior right thigh and C) Ankle area on day 7 of urticarial rash.
Laboratory results showed normal complete blood counts, normal absolute neutrophils with high normal IGE antibodies [5].
Dermatologist advised to continue Benadryl, one tablet per oral two times a day. Though, Benadryl did not response well with symptoms. Rashes lasted for 14 days. Once the symptoms of COVID-19 resolved, rashes also got subsided.
As we look into recent research papers and news there is very few evidences that explains about cutaneous presentation of COVID-19. An early report from dermatologists working with COVID-19 patients in Italy found that, in a group of 88 confirmed positive patients, 20% developed skin symptoms, with a little under half developing a rash at the onset of disease and a little more than half developing it after hospitalization. Of the affected patients, the most common manifestation was erythematous rash or a patchy red rash. A few developed urticaria or hives and one developed chickenpox-like blisters. Specifically, within that sample 14 people developed an erythematous rash (a rash with redness), three developed widespread urticaria (hives) [6].
Similarly, Dr. Rajeev Fernando, an infectious disease expert in Southampton, New York, told the health publication prevention he’s seen rashes “a lot” in coronavirus patients. In France, a medical resident of 27 years old female also presents with urticarial eruption. She was negative for all triggers except later on came out positive for COVID-19 [7,8]. Now days, there is reportable number of cases with urticaria and COVID-19 infection. Some patient reported only urticaria as COVID-19 case without respiratory symptoms. In February, there were three patients who had only urticarial symptoms and later reported as asymptomatic cases of COVID-19 in china [9].
There is one paper published in Cleveland Journal of Medicine, which has explained all types of rashes associated with COVID-19. Thailand, where the COVID-19 infection occurred since early January 2020. There was an interesting case in which the patient presented with a skin rash with petechiae. The patient was initially misdiagnosed as dengue, which resulted in a delayed diagnosis of COVID-19. Patient had an oropharyngeal swab for COVID-19 testing, which came out positive and had a good response to the treatment [10].
This case as patient developed urticaria on 12th day of COVID-19 is a rare presentation. Rash may be a rare presenting symptom of COVID-19 and should be kept in mind by all health care provider.
As we see, different type of rashes can present before COVID-19 symptoms, with respiratory symptoms and even as only presenting symptoms for COVID-19.
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Citation: Neupane N. "A Case Report on COVID-19 Infection and Cutaneous Presentation". Dermatol Case Rep, 2024, 9(1), 1-2.
Received: 11-Jun-2020, Manuscript No. DMCR-24-4875; Editor assigned: 16-Jun-2020, Pre QC No. DMCR-24-4875 (PQ); Reviewed: 30-Jun-2020, QC No. DMCR-24-4875; Revised: 15-May-2024, Manuscript No. DMCR-24-4875 (R); Published: 12-Jun-2024, DOI: 10.37532/2684-124X.24.9.1.004
Copyright: © 2024 Neupane N. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
