PDF(Pubmed)
Abstract：
BACKGROUND: Despite the large number of articles published on skin lesions related to COVID-19, clinicopathological correlation has not been performed consistently and immunohistochemistry to demonstrate spike 3 protein expression has not been validated through RT-PCR.
METHODS: We compiled 69 cases of patients with confirmed COVID-19, where skin lesions were clinically and histopathologically studied. Immunohistochemistry (IHC) and RT-PCR was performed in skin biopsies.
RESULTS: After a careful review of the cases, 15 were found to be dermatosis not related to COVID-19, while the rest of the lesions could be classified according to their clinical characteristics as vesicular (4), maculopapular eruptions (41), urticariform (9), livedo and necrosis (10) and pernio-like (5). Although histopathological features were similar to previously reported results, we found two previously unreported findings, maculopapular eruptions with squamous eccrine syringometaplasia and neutrophilic epitheliotropism. IHC showed in some cases endothelial and epidermal staining but RT-PCR was negative in all the tested cases. Thus, direct viral involvement could not be demonstrated.
CONCLUSIONS: Despite presenting the largest series of confirmed COVID-19 patients with histopathologically studied skin manifestations, direct viral involvement was difficult to establish. Vasculopathic and urticariform lesions seem to be those more clearly related to the viral infection, despite IHC or RT-PCR negative results failed to demonstrate viral presence. These findings, as in other dermatological areas, highlight the need of a clinico-pathological correlation to increase knowledge about viral involvement in COVID-19 skin-related lesions.
METHODS: We compiled 69 cases of patients with confirmed COVID-19, where skin lesions were clinically and histopathologically studied. Immunohistochemistry (IHC) and RT-PCR was performed in skin biopsies.
RESULTS: After a careful review of the cases, 15 were found to be dermatosis not related to COVID-19, while the rest of the lesions could be classified according to their clinical characteristics as vesicular (4), maculopapular eruptions (41), urticariform (9), livedo and necrosis (10) and pernio-like (5). Although histopathological features were similar to previously reported results, we found two previously unreported findings, maculopapular eruptions with squamous eccrine syringometaplasia and neutrophilic epitheliotropism. IHC showed in some cases endothelial and epidermal staining but RT-PCR was negative in all the tested cases. Thus, direct viral involvement could not be demonstrated.
CONCLUSIONS: Despite presenting the largest series of confirmed COVID-19 patients with histopathologically studied skin manifestations, direct viral involvement was difficult to establish. Vasculopathic and urticariform lesions seem to be those more clearly related to the viral infection, despite IHC or RT-PCR negative results failed to demonstrate viral presence. These findings, as in other dermatological areas, highlight the need of a clinico-pathological correlation to increase knowledge about viral involvement in COVID-19 skin-related lesions.
摘要：
背景：尽管发表了大量关于与COVID-19相关的皮肤病变的文章，但临床病理相关性尚未得到一致的进行，免疫组织化学显示spike3蛋白表达也未通过RT-PCR得到验证。我们收集了69例确诊为COVID-19的患者，对其皮肤病变进行了临床和组织病理学研究。在皮肤活检中进行免疫组织化学(IHC)和RT-PCR。
结果：经过对病例的仔细审查，发现15例与COVID-19无关的皮肤病，而其余病变可根据其临床特征分类为水疱(4)，斑丘疹(41),荨麻疹状（9），livedo和坏死（10）和pernio样（5）。尽管组织病理学特征与先前报道的结果相似，我们发现了两个以前未报告的发现,斑丘疹伴鳞状小汗腺增生和嗜中性粒细胞上皮性增生。IHC在某些情况下显示内皮和表皮染色，但所有测试病例的RT-PCR均为阴性。因此，无法证明病毒的直接参与。
结论：尽管出现了一系列最大的确诊COVID-19患者，其组织病理学研究为皮肤表现，病毒的直接参与很难确定.血管扩张和荨麻疹样病变似乎与病毒感染更明显相关，尽管IHC或RT-PCR阴性结果未能证明病毒存在.这些发现,与其他皮肤病学领域一样，强调需要进行临床病理相关性研究，以增加对病毒累及COVID-19皮肤相关病变的认识。
结果：经过对病例的仔细审查，发现15例与COVID-19无关的皮肤病，而其余病变可根据其临床特征分类为水疱(4)，斑丘疹(41),荨麻疹状（9），livedo和坏死（10）和pernio样（5）。尽管组织病理学特征与先前报道的结果相似，我们发现了两个以前未报告的发现,斑丘疹伴鳞状小汗腺增生和嗜中性粒细胞上皮性增生。IHC在某些情况下显示内皮和表皮染色，但所有测试病例的RT-PCR均为阴性。因此，无法证明病毒的直接参与。
结论：尽管出现了一系列最大的确诊COVID-19患者，其组织病理学研究为皮肤表现，病毒的直接参与很难确定.血管扩张和荨麻疹样病变似乎与病毒感染更明显相关，尽管IHC或RT-PCR阴性结果未能证明病毒存在.这些发现,与其他皮肤病学领域一样，强调需要进行临床病理相关性研究，以增加对病毒累及COVID-19皮肤相关病变的认识。
