No SARS-CoV-2 antibody response in 25 patients with pseudo-chilblains.

Chilblain-like acral lesions have been identified in some coronavirus disease 2019 (COVID-19) patients. It has been suggested that these pseudo-chilblains could be a specific marker of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Most patients with these lesions have had negative polymerase chain reactions (PCRs), but some authors believe serology tests are likely to give positive results. We designed a prospective study including all patients with pseudo-chilblains treated in outpatient department in April and May 2020 and then performed SARS-CoV-2 PCR and serology tests on all available patients. We evaluated 59 patients, of whom 17 had undergone PCR before the study period, all with negative results. For the present study, we performed 20 additional PCRs, serology tests in 25 patients, and a parvovirus B19 antibody test in 15 patients. All results were negative. Our findings counter the hypothesis that serology is likely to reveal SARS-CoV-2 infection in patients with pseudo-chilblains. One hypothesis for our negative results is that the time period between symptom onset and antibody production is longer in these patients; another is that the lesions are caused by behavioral changes during lockdown rather than SARS-CoV-2 infection. We nevertheless maintain that COVID-19 should be ruled out in people presenting with chilblain-like lesions.

Hidradenitis Suppurativa is Associated with Non-alcoholic Fatty Liver Disease: A Cross-sectional Study.

Non-alcoholic fatty liver disease (NAFLD) is currently the most common cause of end-stage liver disease. The aim of this controlled cross-sectional study was to assess the association between NAFLD and hidradenitis suppurativa. NAFLD was assessed using hepatic ultrasound. A total of 125 patients with hidradenitis suppurativa and 120 patients without hidradenitis suppurativa were recruited, matched for age, sex and body mass index (< 25 or ≥ 25 kg/m2), a risk factor related to NAFLD. Both groups presented similar proportions of overweight or obesity (89.6% vs 90%). Patients with hidradenitis suppurativa presented significantly higher prevalence of NAFLD compared with those with non- hidradenitis suppurativa (57.6% vs 31.7%, p < 0.001). Multivariable analysis confirmed independent association between hidradenitis suppurativa and NAFLD (odds ratio 2.79, 95% confidence interval 1.48-5.25; p = 0.001) besides age, body mass index, hypertension and hypertransaminasaemia. Hidradenitis suppurativa is significantly associated with the development of NALFD regardless of the presence of classic metabolic risk factors.

Identification of bacterial DNA in the peripheral blood of patients with active hidradenitis suppurativa.

Bacterial translocation may have a role in the pathogenesis of several inflammatory conditions. A prospective analytical case-control study was designed to assess the presence of bacterial DNA in the peripheral blood of patients with hidradenitis suppurativa (HS). An age- and gender-matched control population was recruited from healthy blood donors. Demographic and HS-related data were also collected. We took fasting blood samples from each participant and determined the presence of bacterial DNA (including bacterial species identification) and levels TNF-α, IL-1ß, and IL-17A. We included 50 patients with HS and 50 healthy controls. Bacterial DNA was present in 17 (34.0%) cases vs. 2 (4.0%) controls (P < 0.001); 14/17 (82.4%) bacterial species identified in HS patients were Gram-negative bacilli, especially Escherichia coli. The presence of bacterial DNA in patients with HS was associated with elevated levels of TNF-α (P < 0.001), IL-1ß (P = 0.01) and IL-17 (P < 0.001); however, it was not associated with disease severity or disease location. BactDNA in the peripheral blood of patients with active HS is more common that in healthy controls, and it is associated with higher levels of proinflammatory cytokines. We hypothesized that BT from the skin/intestinal lumen may play a relevant role in the pathogenesis of HS.