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{{Nuha}}
{{Nuha}}
==chilblain‐like lesions==
the lesion was red–purple papules on the dorsal aspect of the fingers on both hands and diffused erythema in the subungual area of thumb.<ref name="pmid32302422">{{cite journal| author=Alramthan A, Aldaraji W| title=Two cases of COVID-19 presenting with a clinical picture resembling chilblains: first report from the Middle East. | journal=Clin Exp Dermatol | year= 2020 | volume=  | issue=  | pages=  | pmid=32302422 | doi=10.1111/ced.14243 | pmc=7264553 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32302422  }} </ref>
===historical respective===
*in Qater,two cases of COVID‐19 presenting with cutaneous lesions, specifically, chilblain‐like lesions.
*Hunt and Koziatek reported a case of COVID‐19 presenting with fever and morbilliform rash as the primary presenting symptoms.<ref name="HuntKoziatek2020">{{cite journal|last1=Hunt|first1=Madison|last2=Koziatek|first2=Christian|title=A Case of COVID-19 Pneumonia in a Young Male with Full Body Rash as a Presenting Symptom|journal=Clinical Practice and Cases in Emergency Medicine|volume=4|issue=2|year=2020|issn=2474252X|doi=10.5811/cpcem.2020.3.47349}}</ref>
*while Joob and Wiwanitkit reported a case of COVID‐19 presenting initially with a petechial skin rash in Thailand.<ref name="pmid32213305">{{cite journal| author=Joob B, Wiwanitkit V| title=COVID-19 can present with a rash and be mistaken for dengue. | journal=J Am Acad Dermatol | year= 2020 | volume= 82 | issue= 5 | pages= e177 | pmid=32213305 | doi=10.1016/j.jaad.2020.03.036 | pmc=7156802 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32213305  }} </ref>
===pathophysiology===
*Degeneration and necrosis of parenchymal cells and formation of hyaline thrombi in small vessels were observed in lung and other organs.<ref name="pmid32172546">{{cite journal| author=Yao XH, Li TY, He ZC, Ping YF, Liu HW, Yu SC | display-authors=etal| title=[A pathological report of three COVID-19 cases by minimal invasive autopsies]. | journal=Zhonghua Bing Li Xue Za Zhi | year= 2020 | volume= 49 | issue= 5 | pages= 411-417 | pmid=32172546 | doi=10.3760/cma.j.cn112151-20200312-00193 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32172546  }} </ref>
==Acute acro-ischemia in the child==
*the presentations of acro-ischemia  including finger/toe cyanosis, skin bulla and dry gangrene.<ref name="pmid32447934">{{cite journal| author=Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J | display-authors=etal| title=[Clinical and coagulation characteristics in 7 patients with critical COVID-2019 pneumonia and acro-ischemia]. | journal=Zhonghua Xue Ye Xue Za Zhi | year= 2020 | volume= 41 | issue= 4 | pages= 302-307 | pmid=32447934 | doi=10.3760/cma.j.issn.0253-2727.2020.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32447934  }} </ref>
*Mazzotta and Troccoli reported a few dozen cases, initially presenting with red–purple papules on the feet and hands, which either evolved into haemorrhagic bullae or developed a blackish crust.<ref name="pmidhttps://doi.org/10.26326/2281-9649.30.2.2102">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.26326/2281-9649.30.2.2102 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10  }} </ref>
===pathophysiology===
they could be the expression of secondary  microthrombosis  due  to  endothelial  damage and vascular disorders.<ref name="pmid32447934">{{cite journal| author=Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J | display-authors=etal| title=[Clinical and coagulation characteristics in 7 patients with critical COVID-2019 pneumonia and acro-ischemia]. | journal=Zhonghua Xue Ye Xue Za Zhi | year= 2020 | volume= 41 | issue= 4 | pages= 302-307 | pmid=32447934 | doi=10.3760/cma.j.issn.0253-2727.2020.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32447934  }} </ref>
===lab results===
*D-dimer, fibrinogen and fibrinogen degradation product (FDP) were significantly elevated in most patients.
*Prothrombin time was prolonged in 4 patients. D-dimer and FDP levels progressively elevated consistent with COVID-2019 exacerbation.
*Four patients were diagnosed with disseminated intravascular coagulation (DIC) .
*Low molecular weight heparin (LMWH) was administrated in 6 patients, which reduced D-dimer and FDP rather than improved clinical symptoms.<ref name="pmid32447934">{{cite journal| author=Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J | display-authors=etal| title=[Clinical and coagulation characteristics in 7 patients with critical COVID-2019 pneumonia and acro-ischemia]. | journal=Zhonghua Xue Ye Xue Za Zhi | year= 2020 | volume= 41 | issue= 4 | pages= 302-307 | pmid=32447934 | doi=10.3760/cma.j.issn.0253-2727.2020.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32447934  }} </ref>
=erythematous rash
=widespread urticaria
=chicken‐pox like vesicles.

Revision as of 13:08, 15 June 2020


Nuha Al-Howthi, MD[1]

chilblain‐like lesions

the lesion was red–purple papules on the dorsal aspect of the fingers on both hands and diffused erythema in the subungual area of thumb.[1]

historical respective

  • in Qater,two cases of COVID‐19 presenting with cutaneous lesions, specifically, chilblain‐like lesions.
  • Hunt and Koziatek reported a case of COVID‐19 presenting with fever and morbilliform rash as the primary presenting symptoms.[2]
  • while Joob and Wiwanitkit reported a case of COVID‐19 presenting initially with a petechial skin rash in Thailand.[3]

pathophysiology

  • Degeneration and necrosis of parenchymal cells and formation of hyaline thrombi in small vessels were observed in lung and other organs.[4]


Acute acro-ischemia in the child

  • the presentations of acro-ischemia including finger/toe cyanosis, skin bulla and dry gangrene.[5]
  • Mazzotta and Troccoli reported a few dozen cases, initially presenting with red–purple papules on the feet and hands, which either evolved into haemorrhagic bullae or developed a blackish crust.[6]

pathophysiology

they could be the expression of secondary microthrombosis due to endothelial damage and vascular disorders.[5]

lab results

  • D-dimer, fibrinogen and fibrinogen degradation product (FDP) were significantly elevated in most patients.
  • Prothrombin time was prolonged in 4 patients. D-dimer and FDP levels progressively elevated consistent with COVID-2019 exacerbation.
  • Four patients were diagnosed with disseminated intravascular coagulation (DIC) .
  • Low molecular weight heparin (LMWH) was administrated in 6 patients, which reduced D-dimer and FDP rather than improved clinical symptoms.[5]


=erythematous rash =widespread urticaria =chicken‐pox like vesicles.

  1. ↑ Alramthan A, Aldaraji W (2020). "Two cases of COVID-19 presenting with a clinical picture resembling chilblains: first report from the Middle East". Clin Exp Dermatol. doi:10.1111/ced.14243. PMC 7264553 Check |pmc= value (help). PMID 32302422 Check |pmid= value (help).
  2. ↑ Hunt, Madison; Koziatek, Christian (2020). "A Case of COVID-19 Pneumonia in a Young Male with Full Body Rash as a Presenting Symptom". Clinical Practice and Cases in Emergency Medicine. 4 (2). doi:10.5811/cpcem.2020.3.47349. ISSN 2474-252X.
  3. ↑ Joob B, Wiwanitkit V (2020). "COVID-19 can present with a rash and be mistaken for dengue". J Am Acad Dermatol. 82 (5): e177. doi:10.1016/j.jaad.2020.03.036. PMC 7156802 Check |pmc= value (help). PMID 32213305 Check |pmid= value (help).
  4. ↑ Yao XH, Li TY, He ZC, Ping YF, Liu HW, Yu SC; et al. (2020). "[A pathological report of three COVID-19 cases by minimal invasive autopsies]". Zhonghua Bing Li Xue Za Zhi. 49 (5): 411–417. doi:10.3760/cma.j.cn112151-20200312-00193. PMID 32172546 Check |pmid= value (help).
  5. ↑ 5.0 5.1 5.2 Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J; et al. (2020). "[Clinical and coagulation characteristics in 7 patients with critical COVID-2019 pneumonia and acro-ischemia]". Zhonghua Xue Ye Xue Za Zhi. 41 (4): 302–307. doi:10.3760/cma.j.issn.0253-2727.2020.008. PMID 32447934 Check |pmid= value (help).
  6. ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.26326/2281-9649.30.2.2102 Check |pmid= value (help).
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