Follow-up of skin lesions during COVID-19: a description of a DRESS case
Abstract
We read with interest the paper by De Medeiros et al. regarding the follow-up of skin lesions during COVID-19; they suggest that we must pay attention to other aetiologies such as reactivation of other viral coexistent infections or other factors. We would like to add another report to confirm that some cutaneous manifestations during COVID-19 are secondary and not directly related to SARS-CoV-2, demonstrating that it might only be a bystander in a critical illness where indirect immune injury plays an important role and the use of multiple medications is required. We observed a 50-year-old female who developed abrupt onset of fever, morbilliform exanthema (80% of BSA) with severe pruritus and facial oedema after 34 days from COVID-19 onset of symptoms (day-0) and after 26 days of intensive care unit (ICU) admission (Fig. 1). Detailed laboratory investigations during the last 40 days of admission are shown in Fig. 2. Ten days (day-24) prior to the onset of the exanthema, levofloxacin 500 mg bid i.v was introduced due to Klebsiella aerogenes nosocomial infection. At the onset of the exanthema (day-34), eosinophils count started to increase (peak of 5.73 × 109 cells/L) associated with lymphocytosis (3.48 × 109 cells/L), increase of protein-C-reactive (28.7 mg/L) and alanine transaminase (63 U/L) and normal creatinine (Fig. 2). Mediastinal lymph node enlargement, persistent interstitial pneumonia and liver enlargement were seen on control computer tomography after the onset of…
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