The COVID rash that puts the 'U' in GROUCH!

Abstract

As COVID-19 continues, there are new manifestations and less common presentations of this illness of which we need to be aware. This case describes a 44-year-old woman with a new-onset rash on her lower back and inner thighs. Based on a punch biopsy of both locations, either severe urticaria or early urticarial vasculitis was diagnosed. The patient recovered after treatment with a combination of oral steroids and high-dose antihistamines. Two days after the biopsy, she tested positive for SARS-CoV-2. The urticarial vasculitic reaction was likely secondary to infection from COVID-19 and was the initial presentation of the disease.

Keywords: COVID-19; cutaneous manifestations; dermatology; rash; urticarial vasculitis.

Figure 1.

(a) Polycyclic edematous erythematous plaques without scale with violaceous discoloration centrally. (b, c) Sections displayed a normal-appearing epidermis with a brisk mixed perivascular infiltrate composed of eosinophils, neutrophils and neutrophil fragments, lymphocytes, and extravasated red blood cells. Focal fibrinoid necrosis of blood vessel walls was seen within the mid dermis and vascular endothelial cells appear swollen.