RESUMO
Background Despite the large number of articles published on skin lesions related to COVID-19, clinicopathological correlation has not been performed consistently and immunohistochemistry to demonstrate spike 3 protein expression has not been validated through RT-PCR. Material and method We compiled 69 cases of patients with confirmed COVID-19, where skin lesions were clinically and histopathologically studied. Immunohistochemistry (IHC) and RT-PCR was performed in skin biopsies. Results After a careful review of the cases, 15 were found to be dermatosis not related to COVID-19, while the rest of the lesions could be classified according to their clinical characteristics as vesicular (4), maculopapular eruptions (41), urticariform (9), livedo and necrosis (10) and pernio-like (5). Although histopathological features were similar to previously reported results, we found two previously unreported findings, maculopapular eruptions with squamous eccrine syringometaplasia and neutrophilic epitheliotropism. IHC showed in some cases endothelial and epidermal staining but RT-PCR was negative in all the tested cases. Thus, direct viral involvement could not be demonstrated. Conclusions Despite presenting the largest series of confirmed COVID-19 patients with histopathologically studied skin manifestations, direct viral involvement was difficult to establish. Vasculopathic and urticariform lesions seem to be those more clearly related to the viral infection, despite IHC or RT-PCR negative results failed to demonstrate viral presence. These findings, as in other dermatological areas, highlight the need of a clinico-pathological correlation to increase knowledge about viral involvement in COVID-19 skin-related lesions (AU)
Antecedentes A pesar del gran número de artículos publicados sobre las lesiones cutáneas relacionadas con la COVID-19, no se ha realizado una correlación clinicopatológica de manera consistente, y no ha sido validado el estudio de inmunohistoquímica para demostrar la expresión de la proteína spike 3 mediante RT-PCR. Material y métodos Recopilamos 69 casos de pacientes con COVID-19 confirmada, en los que se estudiaron las lesiones cutáneas a nivel clínico e histopatológico, habiéndose realizado la prueba inmunohistoquímica (IHQ) y RT-PCR en las biopsias cutáneas. Resultados Tras una revisión detallada de los casos, en 15 de ellos se encontró que la dermatosis no guardaba relación con la COVID-19, mientras que el resto de las lesiones podrían clasificarse de acuerdo con sus características clínicas como vesiculares (4), erupciones maculopapulares (41), urticariformes (9), livedo y necrosis (10) y de tipo perniosis (5). Aunque las características histopatológicas fueron similares a los resultados previamente reportados, encontramos dos hallazgos no reportados previamente: erupciones maculopapulares con siringometaplasia ecrina escamosa y epiteliotropismo neutrofílico. La IHQ reflejó en ciertos casos tinción endotelial y epidérmica, pero la prueba RT-PCR fue negativa en todos los casos probados. Por ello no pudo demostrarse el compromiso viral directo. Conclusiones A pesar de presentar la mayor serie de pacientes con COVID-19 confirmada y manifestaciones cutáneas histopatológicamente estudiadas, el compromiso viral directo fue difícil de establecer. Las lesiones vasculopáticas e urticariformes parecen ser las más claramente relacionadas con la infección viral, a pesar de que los resultados negativos de la IHQ o RT-PCR no pudieron demostrar la presencia viral (AU)
Assuntos
Humanos , Infecções por Coronavirus/complicações , Dermatopatias/diagnóstico , Dermatopatias/virologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Imuno-Histoquímica , BiópsiaRESUMO
Antecedentes A pesar del gran número de artículos publicados sobre las lesiones cutáneas relacionadas con la COVID-19, no se ha realizado una correlación clinicopatológica de manera consistente, y no ha sido validado el estudio de inmunohistoquímica para demostrar la expresión de la proteína spike 3 mediante RT-PCR. Material y métodos Recopilamos 69 casos de pacientes con COVID-19 confirmada, en los que se estudiaron las lesiones cutáneas a nivel clínico e histopatológico, habiéndose realizado la prueba inmunohistoquímica (IHQ) y RT-PCR en las biopsias cutáneas. Resultados Tras una revisión detallada de los casos, en 15 de ellos se encontró que la dermatosis no guardaba relación con la COVID-19, mientras que el resto de las lesiones podrían clasificarse de acuerdo con sus características clínicas como vesiculares (4), erupciones maculopapulares (41), urticariformes (9), livedo y necrosis (10) y de tipo perniosis (5). Aunque las características histopatológicas fueron similares a los resultados previamente reportados, encontramos dos hallazgos no reportados previamente: erupciones maculopapulares con siringometaplasia ecrina escamosa y epiteliotropismo neutrofílico. La IHQ reflejó en ciertos casos tinción endotelial y epidérmica, pero la prueba RT-PCR fue negativa en todos los casos probados. Por ello no pudo demostrarse el compromiso viral directo. Conclusiones A pesar de presentar la mayor serie de pacientes con COVID-19 confirmada y manifestaciones cutáneas histopatológicamente estudiadas, el compromiso viral directo fue difícil de establecer. Las lesiones vasculopáticas e urticariformes parecen ser las más claramente relacionadas con la infección viral, a pesar de que los resultados negativos de la IHQ o RT-PCR no pudieron demostrar la presencia viral (AU)
Background Despite the large number of articles published on skin lesions related to COVID-19, clinicopathological correlation has not been performed consistently and immunohistochemistry to demonstrate spike 3 protein expression has not been validated through RT-PCR. Material and method We compiled 69 cases of patients with confirmed COVID-19, where skin lesions were clinically and histopathologically studied. Immunohistochemistry (IHC) and RT-PCR was performed in skin biopsies. Results After a careful review of the cases, 15 were found to be dermatosis not related to COVID-19, while the rest of the lesions could be classified according to their clinical characteristics as vesicular (4), maculopapular eruptions (41), urticariform (9), livedo and necrosis (10) and pernio-like (5). Although histopathological features were similar to previously reported results, we found two previously unreported findings, maculopapular eruptions with squamous eccrine syringometaplasia and neutrophilic epitheliotropism. IHC showed in some cases endothelial and epidermal staining but RT-PCR was negative in all the tested cases. Thus, direct viral involvement could not be demonstrated. Conclusions Despite presenting the largest series of confirmed COVID-19 patients with histopathologically studied skin manifestations, direct viral involvement was difficult to establish. Vasculopathic and urticariform lesions seem to be those more clearly related to the viral infection, despite IHC or RT-PCR negative results failed to demonstrate viral presence. These findings, as in other dermatological areas, highlight the need of a clinico-pathological correlation to increase knowledge about viral involvement in COVID-19 skin-related lesions (AU)
Assuntos
Humanos , Infecções por Coronavirus/complicações , Dermatopatias/diagnóstico , Dermatopatias/virologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Imuno-Histoquímica , BiópsiaRESUMO
BACKGROUND: Despite the large number of articles published on skin lesions related to COVID-19, clinicopathological correlation has not been performed consistently and immunohistochemistry to demonstrate spike 3 protein expression has not been validated through RT-PCR. MATERIAL AND METHODS: We compiled 69 cases of patients with confirmed COVID-19, where skin lesions were clinically and histopathologically studied. Immunohistochemistry (IHC) and RT-PCR was performed in skin biopsies. RESULTS: After a careful review of the cases, 15 were found to be dermatosis not related to COVID-19, while the rest of the lesions could be classified according to their clinical characteristics as vesicular (4), maculopapular eruptions (41), urticariform (9), livedo and necrosis (10) and pernio-like (5). Although histopathological features were similar to previously reported results, we found two previously unreported findings, maculopapular eruptions with squamous eccrine syringometaplasia and neutrophilic epitheliotropism. IHC showed in some cases endothelial and epidermal staining but RT-PCR was negative in all the tested cases. Thus, direct viral involvement could not be demonstrated. CONCLUSIONS: Despite presenting the largest series of confirmed COVID-19 patients with histopathologically studied skin manifestations, direct viral involvement was difficult to establish. Vasculopathic and urticariform lesions seem to be those more clearly related to the viral infection, despite IHC or RT-PCR negative results failed to demonstrate viral presence. These findings, as in other dermatological areas, highlight the need of a clinico-pathological correlation to increase knowledge about viral involvement in COVID-19 skin-related lesions.
RESUMO
BACKGROUND: Despite the large number of articles published on skin lesions related to COVID-19, clinicopathological correlation has not been performed consistently and immunohistochemistry to demonstrate spike 3 protein expression has not been validated through RT-PCR. MATERIAL AND METHODS: We compiled 69 cases of patients with confirmed COVID-19, where skin lesions were clinically and histopathologically studied. Immunohistochemistry (IHC) and RT-PCR was performed in skin biopsies. RESULTS: After a careful review of the cases, 15 were found to be dermatosis not related to COVID-19, while the rest of the lesions could be classified according to their clinical characteristics as vesicular (4), maculopapular eruptions (41), urticariform (9), livedo and necrosis (10) and pernio-like (5). Although histopathological features were similar to previously reported results, we found two previously unreported findings, maculopapular eruptions with squamous eccrine syringometaplasia and neutrophilic epitheliotropism. IHC showed in some cases endothelial and epidermal staining but RT-PCR was negative in all the tested cases. Thus, direct viral involvement could not be demonstrated. CONCLUSIONS: Despite presenting the largest series of confirmed COVID-19 patients with histopathologically studied skin manifestations, direct viral involvement was difficult to establish. Vasculopathic and urticariform lesions seem to be those more clearly related to the viral infection, despite IHC or RT-PCR negative results failed to demonstrate viral presence. These findings, as in other dermatological areas, highlight the need of a clinico-pathological correlation to increase knowledge about viral involvement in COVID-19 skin-related lesions.
