SARS-CoV-2 infection as a potential triggering factor for urticarial vasculitis during pregnancy: A case report

Abstract

During the COVID-19 pandemic, physicians must maintain a high index of suspicion for COVID-19 in cases of urticarial vasculitis or other forms of urticaria. This is particularly important for acute presentations in otherwise asymptomatic individuals and pregnant women, where a prompt approach to the patient can prevent undesirable complications.

Keywords: COVID‐19; SARS‐CoV‐2; pregnancy; urticaria; urticarial vasculitis; vasculitis.

FIGURE 1

(A, B) Erythematous plaques on both extremities on the second day of disease onset. (C) Erythematous wheals with postinflammatory hyperpigmentation (PIH) on the 7th day. (D) Complete resolution of the skin lesions with mild PIH on the 10th day of treatment

FIGURE 2

(A‐C) Sections show skin tissue with normal epidermal thickness, mild basket weave orthokeratosis, mild spongiosis, and focal vacuolar interface reaction. There is mild perivascular infiltration of lymphocytes in the upper dermis accompanied by swelling of endothelial cells, narrowing of the vascular lumen, and mild extravasation of red blood cells. A few eosinophils are also present in the infiltrate (H&E, ×200, ×400, and ×400, respectively). (D) Mild interstitial mucin deposition in the upper dermis is noted (Alcian blue stain, ×400). These findings are most in favor of an urticarial vasculopathic reaction associated with viral disease (COVID‐19)

FIGURE 3

Timeline of clinical presentations, interventions, and outcomes in the patient