GENERALIZED URTICARIA AS A VASCULITIC MANIFESTATION IN A PATIENT WITH SARS-CoV-2 INFECTION: A CASE REPORT IN COLOMBIA

Daniela  Sepúlveda-Beltran; Alvaro  Mondragón-Cardona; Carlos Enrique  Conde-Martin; Oscar Alberto  Lopez-Guevara; Nubia Rocio  Hernandez-Rojas; Mario Alberto  Caviedes-Cleves; David E.  Gutierrez-Ortega; Carmen R.  Rangel-Meza; Franci Karina  Conde-Tavera; Alfonso J.  Rodriguez-Morales; Kuldeep  Dhama

doi:10.18006/2021.9(2).131.137

Authors

Daniela Sepúlveda-Beltran Internal Medicine Department, Sociedad Clínica Emcosalud, Neiva, Huila, Colombia https://orcid.org/0000-0003-0035-2017
Alvaro Mondragón-Cardona Internal Medicine Department, Sociedad Clínica Emcosalud, Neiva, Huila, Colombia https://orcid.org/0000-0001-5577-5434
Carlos Enrique Conde-Martin Internal Medicine Department, Sociedad Clínica Emcosalud, Neiva, Huila, Colombia https://orcid.org/0000-0002-4929-4420
Oscar Alberto Lopez-Guevara Internal Medicine Department, Sociedad Clínica Emcosalud, Neiva, Huila, Colombia https://orcid.org/0000-0002-1415-3644
Nubia Rocio Hernandez-Rojas Internal Medicine Department, Sociedad Clínica Emcosalud, Neiva, Huila, Colombia https://orcid.org/0000-0002-7930-3404
Mario Alberto Caviedes-Cleves Internal Medicine Department, Sociedad Clínica Emcosalud, Neiva, Huila, Colombia https://orcid.org/0000-0002-4783-2774
David E. Gutierrez-Ortega Internal Medicine Department, Sociedad Clínica Emcosalud, Neiva, Huila, Colombia https://orcid.org/0000-0002-5998-4222
Carmen R. Rangel-Meza Internal Medicine Department, Sociedad Clínica Emcosalud, Neiva, Huila, Colombia https://orcid.org/0000-0003-1131-418X
Franci Karina Conde-Tavera Internal Medicine Department, Sociedad Clínica Emcosalud, Neiva, Huila, Colombia https://orcid.org/0000-0003-1641-5668
Alfonso J. Rodriguez-Morales Latin American Network of Coronavirus Disease 2019 (COVID-19) Research (LANCOVID-19), Pereira, Risaralda, Colombia https://orcid.org/0000-0001-9773-2192
Kuldeep Dhama Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly-243122, Uttar Pradesh, India https://orcid.org/0000-0001-7469-4752

DOI:

https://doi.org/10.18006/2021.9(2).131.137

Keywords:

SARS-CoV2, COVID-19, Autoimmune urticaria, Vasculitis, Colombia

Abstract

Skin manifestations have been reported in up to 20% of cases of SARS-CoV-2 infection, including morbilliform rash (22%), pernio-like acral lesions (18%), urticaria (16%), and macular erythema (13%). It is believed that in the case of SARS-CoV-2 infection, the mechanism involved is an inflammatory response that generates immune dysregulation, vascular congestion, vasculitis, vascular thrombosis, or neoangiogenesis. This case study, present the case of a patient with no previous history of urticarial reactions, autoimmune diseases, or exposure to medications who develops generalized urticaria lasting more than 24 hours and who was diagnosed with SARS-CoV-2 infection by RT-PCR with a nasopharyngeal swab. We suggest in this patient vasculitic urticaria as a manifestation of SARS-CoV-2 infection.

References

Arias-Santiago SA, Almazán-Fernández FM, Burkhardt-Pérez P, Naranjo-Sintes R (2009) Urticaria a frigore asociada a mononucleosis por virus de Epstein-Barr. Actas Dermo-Sifiliográficas 100(5): 435–436. https://doi.org/10.1016/s0001-7310(09)71265-7.

Chen J (2020) Pathogenicity and transmissibility of 2019-nCoV—A quick overview and comparison with other emerging viruses. Microbes and Infection 22(2): 69–71. https://doi.org/10.1016/j.micinf.2020.01.004.

Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK, Bleicker T, Brünink S, Schneider J, Schmidt ML, Mulders DG, Haagmans BL, van der Veer B, et al. (2020) Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 25(3):2000045. https://doi.org/10.2807/1560-7917.ES.2020.25.3.2000045.

Dhama K, Khan S, Tiwari R, Sircar S, Bhat S, Malik YS, Singh KP, Chaicumpa W, Bonilla-Aldana DK, Rodriguez-Morales AJ (2020) Coronavirus Disease 2019-COVID-19. Clinical Microbiology Reviews 33(4):e00028-20.

Freeman EE, McMahon DE, Lipoff JB, Rosenbach M, Kovarik C, Desai SR, Fox LP (2020) The spectrum of COVID-19-associated dermatologic manifestations: an international registry of 716 patients from 31 countries. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2020.06.1016.

Hamming I, Timens W, Bulthuis M, Lely A, Navis G, Goor HV (2004) Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. The Journal of Pathology 203(2): 631–637. https://doi.org/10.1002/path.1570.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Cao B (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet 395(10223): 497–506. https://doi.org/10.1016/s0140-6736(20)30183-5.

Kolivras A, Dehavay F, Delplace D, Feoli F, Meiers I, Milone L, Olemans C, Sass U, Theunis A, Thompson CT, Van De Borne L, Richert B (2020) Coronavirus (COVID-19) infection-induced chilblains: A case report with histopathologic findings. JAAD case reports, 6(6): 489–492. Advance online publication. https://doi.org/10.1016/j.jdcr.2020.04.011.

Kritas SK, Ronconi G, Caraffa A, Gallenga CE, Ross R, Conti P (2020) Mast cells contribute to coronavirus-induced inflammation: new anti-inflammatory strategy. Journal of Biological Regulators and Homeostatic Agents 34(1): 9–14. https://doi.org/10.23812/20-Editorial-Kritas.

Leiste A, Skaletz-Rorowski A, Venten I, Altmeyer P, Brockmeyer NH (2008) Urticaria associated with Norovirus infection: Report of two cases. Journal Der Deutschen Dermatologischen Gesellschaft 6(7): 563–565. https://doi.org/10.1111/j.1610-0387.2007.06501.x.

Loeffelholz MJ, Tang YW (2020) Laboratory diagnosis of emerging human coronavirus infections - the state of the art. Emerging microbes & infections 9(1): 747–756. https://doi.org/10.1080/22221751.2020.1745095.

Lu H, Stratton CW, Tang Y (2020) Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. Journal of Medical Virology 92(4): 401-402. doi:10.1002/jmv.25678.

Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, Baxter-Stoltzfus A, Laurence J (2020) Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Translational research : the journal of laboratory and clinical medicine 220: 1–13. https://doi.org/10.1016/j.trsl.2020.04.007.

Ortiz-Martínez Y, Cabeza-Ruiz LD, Vásquez-Lozano SH, Villamil-Gómez WE, Rodriguez-Morales AJ (2020) Pericarditis in a young internal medicine resident with COVID-19 in Colombia. Travel medicine and infectious disease 37: 101863. https://doi.org/10.1016/j.tmaid.2020.101863.

Recalcati S (2020) Cutaneous manifestations in COVID-19: a first perspective. Journal of the European Academy of Dermatology and Venereology : Journal of the European Academy of Dermatology and Venereology 34(5): e212–e213. https://doi.org/10.1111/jdv.16387.

Recalcati S, Barbagallo T, Frasin L, Prestinari F, Cogliardi A, Provero M, Fantini F (2020) Acral cutaneous lesions in the time of COVID‐19. Journal of the European Academy of Dermatology and Venereology 34(8): 346–347. https://doi.org/10.1111/jdv.16533.

Romaní J, Baselga E, Mitjà O, Riera-Martí N, Garbayo P, Vicente A, Calzado S (2020) Lesiones pernióticas y acrales en España durante el confinamiento por COVID: análisis retrospectivo de 12 casos. Actas Dermo-Sifiliográficas 111(5): 426–429. https://doi.org/10.1016/j.ad.2020.04.002.

Rossi SE, Erasmus JJ, Volpacchio M, Franquet T, Castiglioni T, Mcadams HP (2003) "Crazy-Paving" Pattern at Thin-Section CT of the Lungs: Radiologic-Pathologic Overview. RadioGraphics 23(6): 1509–1519. https://doi.org/10.1148/rg.236035101.

Sheikhzadeh E, Eissa S, Ismail A, Zourob M (2020) Diagnostic techniques for COVID-19 and new developments. Talanta 220: 121392. https://doi.org/10.1016/j.talanta.2020.121392.

Vaduganathan M, Vardeny O, Michel T, McMurray JJV, Pfeffer MA, Solomon SD (2020) Renin–Angiotensin–Aldosterone System Inhibitors in Patients with Covid-19. New England Journal of Medicine 382(17): 1653–1659. https://doi.org/10.1056/nejmsr2005760.

Wang W, Tang J, Wei F (2020) Updated understanding of the

outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. Journal of medical virology 92(4): 441–447. https://doi.org/10.1002/jmv.25689.

Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC (2020) Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19). Journal of the American Medical Association “JAMA” 324(8):782-793. doi:10.1001/jama.2020.12839.

World Health Organization (2020) Coronavirus Disease 2019 (COVID-19) Situation Report – 51.

Yuki K, Fujiogi M, Koutsogiannaki S (2020). COVID-19 pathophysiology: A review. Clinical Immunology 215: 108427. doi:10.1016/j.clim.2020.108427.

Zhang C, Wu Z, Li JW, Zhao H, Wang GQ (2020b) Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality. International Journal of Antimicrobial Agents 55(5): 105954. https://doi.org/10.1016/j.ijantimicag.2020.105954.

Zhang X, Li S, Niu S (2020a) ACE2 and COVID-19 and the resulting ARDS. Postgraduate Medical Journal 96(1137): 403–407. https://doi.org/10.1136/postgradmedj-2020-137935.

Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J, Zhou X, Jiang W, Zhao YQ, Zhang SY, Li TS (2020c) Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi, 41(0): E006. https://doi.org/10.3760/cma.j.issn.0253-2727.2020.0006.

Zhao Q, Fang X, Pang Z, Zhang B, Liu H, Zhang F (2020b) COVID‐19 and cutaneous manifestations: A systematic review. Journal of the European Academy of Dermatology and Venereology 34(11):2505-2510. doi: 10.1111/jdv.16778.

Zhao S, Lin Q, Ran J, Musa SS, Yang G, Wang W, Lou Y, Gao D, Yang L, He D, Wang MH (2020a) Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 92: 214–217. https://doi.org/10.1016/j.ijid.2020.01.050.

Zou X, Chen K, Zou J, Han P, Hao J, Han Z (2020) Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Frontiers of Medicine 14(2): 185–192. https://doi.org/10.1007/s11684-020-0754-0.