背景:自2019年冠状病毒病流行以来,由于感染严重急性呼吸道综合征冠状病毒2而观察到的最常见的皮肤病变是假性冻疮(或冠状病毒病脚趾)。然而,这种病理仍然很少见,难以诊断,因为没有具体的测试存在。
方法:两名白人女性,30岁和22岁,在2019年冠状病毒病大流行的前两波期间,向我们的普通医学单位介绍了脚部的羊膜病病变。他们没有严重急性呼吸道综合症冠状病毒2感染的呼吸道或一般症状,鼻咽拭子的逆转录聚合酶链反应为阴性,血清学仅在第一个病例中呈阳性。两个病例的临床表现不同,因为第二位患者在冷敷后出现肿胀和灼热。诊断是基于临床表现,时间性,排除其他鉴别诊断,和血液检查结果(第一例血清学阳性,第二例CXCL13和VEGF高水平),在当前文献的支持下。第一位患者的病变自发消退。第二例因疼痛管理住院,并接受皮质类固醇治疗,症状缓解。
结论:这两个临床表现不同的病例说明了2019年冠状病毒病的诊断方法,这是一种具有不同表现的挑战性疾病,包括,在某些情况下,冠状病毒病脚趾。我们提供了一篇文献综述,说明了科学研究的进展。与冠状病毒病2019感染相关的皮肤病变可能是重要的1型干扰素反应的表达,应在初级保健环境中进行鉴别诊断。
BACKGROUND: Since the beginning of the coronavirus disease 2019 pandemic, the most common skin lesions observed due to infection with the severe acute respiratory syndrome coronavirus 2 are pseudochilblains (or coronavirus disease toes). However, this pathology remains infrequent and difficult to diagnose, as no specific test exists.
METHODS: Two Caucasian women, 30 and 22 years old, presented to our General Medicine Unit with perniosis lesions on the feet during the first two waves of the coronavirus disease 2019 pandemic. They did not have respiratory or general symptoms of severe acute respiratory syndrome coronavirus 2 infection, the reverse transcription polymerase chain reaction on nasopharyngeal swabs was negative, and the serology was positive only in the first
case. The clinical presentation differed for the two cases, as the second patient suffered from swelling and burning after cold application. The diagnosis was based on clinical presentation, temporality, exclusion of other differential diagnoses, and blood test results (positive serology in the first
case and high level of CXCL13 and VEGF in the second), supported by current literature. Lesions resolved spontaneously in the first patient. The second
case was hospitalized for pain management and received corticosteroid therapy with resolution of the symptoms.
CONCLUSIONS: These two cases with different clinical presentations illustrate the diagnostic approach to coronavirus disease 2019, a challenging disease with diverse manifestations, including, in some cases, coronavirus disease toes. We present a literature review that illustrates the progression of scientific research. Skin lesions associated with coronavirus disease 2019 infection could be the expression of an important interferon type 1 response and should be considered in the differential diagnosis in a primary care setting.