|
?:abstract
|
-
SESSION TITLE: Fellows Critical Care Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: The first confirmed case of COVID-19 was reported in Washington state on January/31/2020 Soon after the California and Washington states outbreaks, New York has become one of the major epicenters of SARS-CoV-2 infections in the world with more than 20,000 fatalities in the metropolitan area The presence of cutaneous manifestations has been rarely described to be associated with the illness We would like to report a case of erythematous and vesicular rash in a critically ill patient who presented to our hospital with suspected symptoms and was confirmed to have COVID-19 CASE PRESENTATION: 36 YO female with PMH of Diabetes and HLD who presented with complaints of worsening malaise, myalgia and fever SARS-CoV-2 real-time polymerase chain reaction confirmed the diagnosis of COVID-19 She was noted to have diffuse erythematous and vesicular rash over her trunk, upper extremities and groin Her clinical picture quickly deteriorated and she was transferred to the ICU for acute hypoxemic respiratory failure requiring intubation and mechanical ventilation due to COVID-19 pneumonia During her hospital course, her rash continued to worsen and evolve Notably, she was exposed to a variety of medications including sulfa drugs Upon dermatology evaluation, skin punch biopsy revealed perivascular dermatitis consistent with viral exanthem versus drug reaction Patient\'s rash was treated with topical triamcinolone with improvement within a week She remains acutely ill in the ICU being managed supportively DISCUSSION: Multiple studies have reported skin rashes thought to be related to SARS COV2 virus infection including rash on hands or feet that resembles chilblains (“COVID toes”), blisters, hives, maculopapular rash, papulosquamous, petechial or livedo (1,2) These rashes are very non-specific and may resemble other illnesses A careful history with specific attention to onset, duration and progression of the rash may guide us to the likely etiology Viral exanthem has been rarely associated with COVID-19 Non-specific rash has been reported in 0 2-1 2% in a cohort of confirmed COVID-19 (3) Our patient’s rash was present on admission and it was noted from her medical record that she was on sulfa drugs and other antibiotics without adverse effects in the past, making a drug reaction less likely The significance of these rashes is still unclear and so is their association with disease severity Additional studies are warranted to determine specific host or pathogen-related factors that contribute to the development of such rashes, especially with the presence of concurrent COVID-19 CONCLUSIONS: Our case underlines the importance of maintaining a high index of awareness for the occurrence and impact of the recognition of COVID19-related dermatological manifestations and its implications on the clinical course of critically ill patients Reference #1: Tang K, Wang Y, Zhang H, Zheng Q, Fang R, Sun Q Cutaneous manifestations of the Coronavirus Disease 2019 (COVID-19): A brief review [published online ahead of print, 2020 May 7] Dermatol Ther 2020;e13528 doi:10 1111/dth 13528 Reference #2: Diaz-Guimaraens B, Dominguez-Santas M, Suarez-Valle A, et al Petechial Skin Rash Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection JAMA Dermatol Published online April 30, 2020 doi:10 1001/jamadermatol 2020 1741 Reference #3: Guan W, Ni Z, Hu Y Clinical characteristics of coronavirus disease 2019 in China N Engl J Med 2020 doi: 10 1056/NEJMoa2002032 DISCLOSURES: No relevant relationships by Obed Adarkwah, source=Web Response No relevant relationships by Louis Gerolemou, source=Web Response No relevant relationships by Wael Kalaji, source=Web Response No relevant relationships by Gaurav Parhar, source=Web Response No relevant relationships by jad sargi, source=Web Response No relevant relationships by Kiran Zaman, source=Web Response
|
![[This page as RDF]](https://research.tib.eu/covid-19/static/rdf-icon.gif){kind=icon}