Erythema multiforme‐like lesions in children and COVID‐19

• Published in: Pediatric dermatology Vol. 37; no. 3; pp. 442 - 446
• Main Authors: Torrelo, Antonio, Andina, David, Santonja, Carlos, Noguera‐Morel, Lucero, Bascuas‐Arribas, Marta, Gaitero‐Tristán, Jara, Alonso‐Cadenas, José Antonio, Escalada‐Pellitero, Silvia, Hernández‐Martín, Ángela, Torre‐Espi, Mercedes, Colmenero, Isabel
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.05.2020; John Wiley and Sons Inc
• Subjects: Adolescent; Betacoronavirus; Biopsy; Case Report; Case reports; chilblains; Child; Children; Coronavirus Infections - complications; Coronavirus Infections - pathology; COVID-19; Endothelial cells; Epithelial cells; Erythema; Erythema multiforme; Erythema Multiforme - diagnosis; Erythema Multiforme - virology; exanthem; Female; Glands; Humans; Immunohistochemistry; Keratinocytes; Male; Pandemics; Pediatrics; pernio; Pneumonia, Viral - complications; Pneumonia, Viral - pathology; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; skin; Skin diseases; Skin lesions; Spike protein; viral diseases; COVID-19; exanthem; SARS-CoV-2; pernio; chilblains; skin; erythema multiforme; viral diseases
• ISSN: 0736-8046; 1525-1470; 1525-1470
• DOI: 10.1111/pde.14246

During examination of cases of chilblains in children and adolescents, we identified four patients who also showed skin lesions similar to erythema multiforme (EM). They had no other known triggers for EM. One of them had a positive PCR for SARS‐CoV‐2, while the other three were negative. Skin biopsies from two patients showed features not typical of EM, such as deep perivascular and perieccrine infiltrate and absence of necrosis of keratinocytes. Immunohistochemistry for SARS‐CoV/SARS‐CoV‐2 spike protein showed granular positivity in endothelial cells and epithelial cells of eccrine glands in both biopsies. All patients had an excellent outcome, and had minimal or no systemic symptoms. The coincidence of EM, a condition commonly related to viruses, and chilblains in the setting of COVID‐19, and the positivity for SARS‐CoV/SARS‐CoV‐2 spike protein by immunohistochemistry strongly suggest a link between EM‐like lesions and SARS‐CoV‐2.