背景:关于COVID-19诱导的冻疮的大量出版物导致了混乱的局面。
方法:这是一项前瞻性单机构研究,于2020年3月15日至5月13日进行。32例患者接受PCR鼻咽拭子。其中,28例患者做了胸部CT扫描,31例患者进行了血液和尿液检查,24例患者进行了皮肤活检,包括免疫组织化学和直接免疫荧光研究,4名患者接受了电子显微镜检查。
结果:COVID-19诱导的冻疮在临床和组织病理学上与其他原因的冻疮相同。尽管有时会观察到血管内血栓,没有患者出现全身性凝血病或严重的临床病程.详尽的临床,放射学,本研究的实验室检查排除了其他主要和次要原因。电子显微镜显示罕见,在两种情况下,可能的病毒颗粒在内皮和内分泌腺内的核心和尖峰范围为120至133nm。
结论:本研究进一步提供了COVID-19相关冻疮的临床病理证据。PCR和抗体检测阴性不排除感染。冻疮预后良好,发生在疾病过程的后期。在任何患者中均未发现全身性凝血病。出现肢端病变的患者应隔离,和冻疮应与血栓性病变区分开(livedoracemosa,退休紫癜,或缺血性肢端坏死)。
BACKGROUND: The abundance of publications of COVID-19-induced chilblains has resulted in a confusing situation.
METHODS: This is a prospective single-institution study from 15 March to 13 May 2020. Thirty-two patients received PCR nasopharyngeal swabs. Of these, 28 patients had a thoracic CT-scan, 31 patients had blood and urine examinations, 24 patients had skin biopsies including immunohistochemical and direct immunofluorescence studies, and four patients had electron microscopy.
RESULTS: COVID-19-induced chilblains are clinically and histopathologically identical to chilblains from other causes. Although intravascular thrombi are sometimes observed, no patient had a systemic coagulopathy or severe clinical course. The exhaustive clinical, radiological, and laboratory work-up in this study ruled-out other primary and secondary causes. Electron microscopy revealed rare, probable viral particles whose core and spikes measured from 120 to 133 nm within endothelium and eccrine glands in two cases.
CONCLUSIONS: This study provides further clinicopathologic evidence of COVID-19-related chilblains. Negative PCR and antibody tests do not rule-out infection. Chilblains represent a good prognosis, occurring later in the disease course. No systemic coagulopathy was identified in any patient. Patients presenting with acral lesions should be isolated, and chilblains should be distinguished from thrombotic lesions (livedo racemosa, retiform purpura, or ischemic acral necrosis).