key: cord-356145-1jgc62jt
authors: García‐Gil, Miguel Fernando; Monte Serrano, Juan; García García, Mar; Barra Borao, Verónica; Matovelle Ochoa, Cristina; Ramirez‐Lluch, Mar; Ara‐Martín, Mariano
title: Acral purpuric lesions associated with coagulation disorders during the COVID‐19 pandemic
date: 2020-07-02
journal: Int J Dermatol
DOI: 10.1111/ijd.15041
sha: 
doc_id: 356145
cord_uid: 1jgc62jt

nan

Different cutaneous manifestations have been described during the COVID-19 pandemic. These include acral erythematous-purpuric lesions reminiscent of perniosis, which are present in 19% of cases with suspected COVID-19 skin lesions. 1 These patients usually have no clinical symptoms related to COVID-19, and the results of their diagnostic tests for SARS-CoV-2 are negative. 2 The presence of other cutaneous manifestations, such as purpuric-petechial eruptions, has been described being distributed in acral areas. 3 In contrast, alterations in coagulation are frequent in patients with COVID-19. An elevated D-dimer level, prolonged prothrombin time, decreased prothrombin activity, and elevated fibrinogen levels are some of such alterations. 4 An 18-year-old male came to the emergency department presenting with purpuric lesions on the inner side and back of his feet, which developed over the course of 5 days (Fig. 1a) .

He also complained of headache and general malaise. No new drugs were given. Three weeks ago, he presented with a catarrhal disorder, which was associated with a papulovesicular rash similar to varicella (Fig. 1b) . The skin biopsy performed showed a perivascular lymphoid infiltrate in the dermis, both superficial and deep. The vessels surrounded by the lymphoid infiltrate had plump endothelial cells, and fibrin was focally present. In some areas, the lymphoid infiltrate was so dense that it obscured the vessel wall (Fig. 2) . Direct immunofluorescence was negative, including antibody-fluorophore conjugates to IgG, IgM, IgA, complement proteins C1q, C3, and C4c, and fibrinogen. This histology is similar to that previously reported. 5 

Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases

Pernio-like skin lesions associated with COVID-19: a case series of 318 patients from 8 countries

Vascular skin symptoms in COVID-19: a French observational study

Coagulation abnormalities and thrombosis in patients with COVID-19

Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients