Case Report of Skin Lesions in COVID-19 Patients in a Private Hospital, Thailand in April 2020.

Abstract

This report examined rash in COVID-19 patients by demonstrating a real case.
The participant was a 28-year-old Thai female, who had no food or drug allergies.
After having a fever for two days, she was detected with a COVID-19 infection together
with muscular pain, rash on the extremities, and watery diarrhea for three times.
Physical examination: There were multiple discrete blanchable erythematous
macules and papules on the upper and lower extremities (both arms and thighs),
no involvement in other parts of the skin area; such as, the conjunctiva, face, oral area,
trunk, genitals, palms, and soles.
Impression: Skin appearance of Coronavirus.
Differential diagnosis: Chikungunya, Zika, measles, rubella, infectious mononucleosis,
dengue fever and dengue hemorrhagic fever, acute retroviral syndrome, secondary syphilis,
Scrub typhus, lepromatous leprosy and Candidiasis.
Laboratory investigation: A complete blood count (CBC) showed no surging
eosinophil, which inferred that there was no internal organ damage from any medication.
A biopsy was not recommended because this would not help to indicate the viral
infection apart from suspecting a severe drug allergy. The liver function and urine analysis
were also normal in this case.
Treatment: Topical corticosteroid; oral antihistamine. In this case, topical
corticosteroid was applied two times per day then the rash faded within two days
without postinflammatory hyperpigmentation.
Conclusion: As COVID-19 is a new emerging disease, the information about skin
lesions in this viral infection is still limited. Furthermore, many articles have reported
different types of skin rash as part of COVID-19, including maculopapular rash (MP rash),
vesicular, urticarial lesion, liveo reticularis, violaceous rash, COVID toe, petechiae and
purpura, and papulosquamous lesions. MP rash is the most common skin lesion from
COVID-19; conversely, the rash was not the indicator for the severity of the infection.
Hence, further study would still be needed.