| Popis: |
SARS-Cov-2’s cutaneous manifestations are polymorphic and increasingly recognized in the literature. Maculopapular rashes, urticaria and chilblains are the most mentioned. We are reporting the case of necrotic lesions localized exclusively on the face in a patient with COVID-19, due to thrombotic microangiopathy. A 17-year-old patient was admitted in February 2021 for necrotic lesions on the face associated with fever evolving for 10 days. No drugs or cocaine were taken before the symptomatology. The patient didn’t report any stings, bites, or applications of corrosive products. He wasn’t vaccinated against the COVID-19. Dermatological examination found infiltrated erythematous and violaceous maculopapular lesions, necrotic and hemorrhagic, without local inflammatory signs on the face and the helix. Cutaneous biopsy showed vascular thrombosis in the dermis and hypodermis without inflammation around the vessels, and perivascular lymphocytic infiltrate. Direct immunofluorescence was negative. Tzanck smear didn't show ballooning cells. COVID-19 serology was positive. Tests searching for autoimmune diseases such as secondary post-infectious vasculitis, primary vasculitis (periarteritis nodosa, Churg and Strauss, cryoglobulinemia, or microscopic polyangiitis), systemic lupus erythematosus, or antiphospholipid syndrome were negative. We didn’t find enough biological signs in favour of hemolysis or disseminated intravascular coagulation. We retained the diagnosis of a thrombopathy associated with COVID-19. The patient was put on corticosteroids with rapid withdrawal, anticoagulants, and petroleum jelly leading to a good evolution. |
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