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Ionescu MA. COVID-19 skin lesions are rarely positive at RT-PCR test: the macrophage activation with vascular impact and SARS-CoV-2-induced cytokine storm. Int J Dermatol. 2021;61(1):3-6doi: 10.1111/ijd.15749.
Ionescu, M. A. (2022). COVID-19 skin lesions are rarely positive at RT-PCR test: the macrophage activation with vascular impact and SARS-CoV-2-induced cytokine storm. International journal of dermatology, 61(1), 3-6. https://doi.org/10.1111/ijd.15749
Ionescu, Marius-Anton. "COVID-19 skin lesions are rarely positive at RT-PCR test: the macrophage activation with vascular impact and SARS-CoV-2-induced cytokine storm." International journal of dermatology vol. 61,1 (2022): 3-6. doi: https://doi.org/10.1111/ijd.15749
Ionescu MA. COVID-19 skin lesions are rarely positive at RT-PCR test: the macrophage activation with vascular impact and SARS-CoV-2-induced cytokine storm. Int J Dermatol. 2022 Jan;61(1):3-6. doi: 10.1111/ijd.15749. Epub 2021 Jul 02. PMID: 34213786; PMCID: PMC8444652.
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Int J Dermatol. 2022 Jan;61(1):3-6. doi: 10.1111/ijd.15749. Epub 2021 Jul 02.

COVID-19 skin lesions are rarely positive at RT-PCR test: the macrophage activation with vascular impact and SARS-CoV-2-induced cytokine storm.

International journal of dermatology

Marius-Anton Ionescu

Affiliations

  1. Dermatology Department, University Hospital "Saint Louis", Paris, France.

PMID: 34213786 PMCID: PMC8444652 DOI: 10.1111/ijd.15749

Abstract

BACKGROUND: Several skin manifestations have been reported since the start of the COVID-19 pandemic: chilblains-like, livedoid lesions, urticaria-like, pseudo-Kawasaki disease, and others. Histopathologic images of these lesions most often show aspects of endothelitis, images similar to autoimmune vasculitis. Cutaneous lesions are often negative at RT-PCR for SARS-CoV-2 virus.

METHOD AND RESULTS: We reviewed recent articles on the mechanisms of COVID-19 and we synthesized main pathways of inflammatory cascade. After the penetration into the cells of the respiratory epithelium, SARS-CoV-2 virus initiates a "cytokine storm" well described in previous publications: the expression of interferon type I (IFN-I) is one of the key elements of the antiviral response in COVID-19 patients, IFN-I expression seems to play an important role in the induction of interleukin 6 (IL-6), chemotactic factors such as Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) and the consequent activation of monocyte-macrophage system followed by the expression of TNF-alpha, and finally by the induction of coagulation factors by both extrinsic and intrinsic pathways.

CONCLUSIONS: The simplified synthesis of the main pathophysiological mechanisms of COVID-19 could help us to understand at least partially the importance of macrophage activation and its vascular involvement in many skin lesions that remain often negative at in situ tests for SARS-CoV-2.

© 2021 the International Society of Dermatology.

References

  1. Merad M, Martin JC. Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nat Rev Immunol 2020; 20: 355-362. - PubMed
  2. Bouaziz JD, Duong T, Jachiet M, et al. Vascular skin symptoms in COVID-19. J Eur Acad Dermatol Venereol 2020; 34: e451-e452. - PubMed
  3. Kolivras A, Dehavay F, Delplace D, et al. Coronavirus (COVID-19) infection induced chilblains: a case report with histopathologic findings. JAAD Case Rep 2020; 6: 489-492. - PubMed
  4. Masson A, Bouaziz JD, Sulimovic L, et al. Chilblains is a common cutaneous finding during the COVID-19 pandemic. J Am Acad Dermatol 2020; 83: 667-670. - PubMed
  5. Rybojad M. COVID-19: des signes cutanés témoins d'une atteinte vasculaire au premier. Réalités Thérapeutiques DV 2020; 292: 7-15. - PubMed
  6. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol 2020; 34: e212-e213. - PubMed
  7. Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy 2020; 75: 1730-1741. - PubMed
  8. Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for dengue. J Am Acad Dermatol 2020; 82: e177. https://doi.org/10.1016/j.jaad.2020.03.036 - PubMed
  9. Marzano AV, Genovese G, Fabbrocini G, et al. Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 22 patients. J Am Acad Dermatol 2020; 83: 280-285. https://doi.org/10.1016/j.jaad.2020.04.044 - PubMed
  10. Zhang Y, Cao W, Xiao M, et al. Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acro-ischemia. Zhonghua Xue Ye Xue Za Zhi 2020; 41: E006. https://doi.org/10.3760/cma.j.issn.0253-2727.2020.0006 - PubMed
  11. Le Cleach L, Dousset L, Assier H, et al. Most chilblains observed during the COVID-19 outbreak occur in patients who are negative for COVID-19 on polymerase chain reaction and serology testing. Br J Dermatol 2020; 183: 866-874. - PubMed
  12. Kanitakis J, Lesort C, Danset M, et al. Chilblain-like acral lesions during the COVID-19 pandemic ("COVID toes"): histologic, immunofluorescence, and immunohistochemical study of 17 cases. J Am Acad Dermatol 2020; 83: 870-875. - PubMed
  13. Sanchez A, Sohier P, Benghanem S, et al. Digitate papulosquamous eruption associated with severe acute respiratory syndrome coronavirus 2 infection. JAMA Dermatol 2020; 156: 819-820. - PubMed
  14. Colmenero I, Santonja C, Alonso-Riaño M, et al. SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases. Br J Dermatol 2020; 183: 729-737. - PubMed
  15. Cascella M, Rajnik M, Cuomo A, et al. Features, evaluation and treatment coronavirus (COVID-19). StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, 2020. - PubMed
  16. Sanders JM, Monogue ML, Jodlowski TZ, et al. Pharmacologic treatments for coronavirus disease 2019 (COVID-19). A review. JAMA 2020; 323: 1824-1836. - PubMed
  17. Dore-Duffy P. Pericytes: pluripotent cells of the blood brain barrier. Curr Pharm Des 2008; 14: 1581-1593. - PubMed
  18. Chen W, Lan Y, Yuan X, et al. Detectable 2019-nCoV viral RNA in blood is a strong indicator for the further clinical severity. Emerg Microb Infect 2020; 9: 469-473. - PubMed
  19. Becker RC. COVID-19 update: Covid-19-associated coagulopathy. J Thromb Thrombolysis 2020; 50: 54-67. - PubMed
  20. Bennett L, Palucka AK, Arce E, et al. Interferon and granulopoiesis signatures in systemic lupus erythematosus blood. J Exp Med 2003; 197: 711-723. - PubMed
  21. Baechler EC, Batliwalla FM, Karypis G, et al. Interferon-inducible gene expression signature in peripheral blood cells of patients with severe lupus. Proc Nat Acad Sci 2003; 100: 2610-2615. - PubMed
  22. Crow MK, Kirou KA, Wohlgemuth J. Microarray analysis of interferon-regulated genes in SLE. Autoimmunity 2003; 36: 481-489. - PubMed
  23. Rönnblom L, Leonard D. Interferon pathway in SLE: one key to unlocking the mystery of the disease. Lupus Sci Med 2019; 6: e000270. - PubMed
  24. Munoz J, Marque M, Dandurand M, et al. Interféronopathies de type I. Ann Dermatol Venereol 2015; 142: 653-663. - PubMed
  25. Kolivras A, Aeby A, Crow Y. Cutaneous histopathological findings of Aicardi-Goutières syndrome, overlap with chilblain lupus. J Cutan Pathol 2008; 35: 774-777. - PubMed
  26. Blanco-Melo D, Nilsson-Payant BE, Liu WC, et al. Imbalanced host response to SARS-CoV-2 drives development of COVID-19. Cell 2020; 181: 1036-1045. - PubMed
  27. McGonagle D, Sharifa K, O'Regand A, et al. The role of cytokines including interleukin-6 in COVID-19 induced pneumonia and macrophage activation syndrome-like disease. Autoimmun Rev 2020; 19: 102537. - PubMed
  28. Iba T, Levy JH, Raj A, et al. Advance in the management of sepsis-induced coagulopathy and disseminated intravascular coagulation. J Clin Med 2019; 8: 728. - PubMed
  29. Velazquez-Salinas L, Verdugo-Rodriguez A, Rodriguez LL, et al. The role of interleukin 6 during viral infections. Front Microbiol 2019; 10: 1057. - PubMed

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