Clinical Cutaneous Features of Patients Infected With SARS-CoV-2 Hospitalized for Pneumonia: A Cross-sectional Study

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a current pandemic worldwide. This virus can reach all organs and disturbs the immune system, leading to a cytokine storm in severe forms. We aimed to report cutaneous features among coronavirus disease 2019 (COVID-19) hospitalized patients.

Methods: We performed a cross-sectional study on 1 given day among all patients hospitalized in acute care for COVID-19 and included all patients with cutaneous features. Follow-up 48 hours later was obtained.

Results: Among 59 adult patients hospitalized on the day of the study in an infectious diseases ward for SARS-CoV-2 infection who were confirmed by molecular assay and/or radiological findings (computed tomography scan), 40 were included. Several cutaneous manifestations were found: macular exanthema (80%), face edema (32%), livedo (13%), urticarial rash (8%), purpura (5%), oral lichenoid lesions (33%), and conjunctivitis (18%). Cutaneous biopsy was performed in 17 patients. Histological findings showed mast cell hyperplasia (100%), superficial perivascular infiltrate of lymphocytes (94%), and superficial edema (47%) consistent with capillary leak.

Conclusions: Various dermatological signs can be encountered during COVID-19. A macular rash was the most frequent. All cutaneous features could be related to a vascular leak process.

Keywords: COVID-19; dermatology; exanthema; pandemics; pneumonia.

Figure 1.

Mean histopathological aspects of rash associated with COVID-19 (haematoxylin, eosin, and saffron, ×100). A, Superficial perivascular infiltrate of lymphocytes (→) with few mast cells, eosinophils, and edema (★) associated with light interface changes (basal cell hydropic degeneration): viral exanthemata aspect (patient 34). B, Important superficial edema especially in pericapillary forming perivascular retraction artifact (★) with a light infiltrate of lymphocytes: capillary leak syndrome aspect (patient 33). C, Inconspicuous edema (collagen fibers appear separated: ★), perivascular and interstitial infiltrate with few sparse eosinophils (→): urticaria aspect (patient 36).