Piel y SARS-CoV-2 en pediatría

Autores/as

DOI:

https://doi.org/10.29262/ram.v69i1.1000

Palabras clave:

Piel, Eritema pernio, SARS-CoV-2, Vasculitis

Resumen

La presentación clínica, curso de la enfermedad y resultado de la infección por SARS-CoV-2 en pediatría difieren de los observados en adultos. En una revisión de Hoang et al. se estimó que la prevalencia de las manifestaciones dermatológicas fue de 0.25 % de un total de 2445 niños con COVID-19 confirmada. Según Parri, se documentó 3 % en 100 niños. En la revisión sistemática de Shah et al. se analizaron 13 estudios que incluyeron 149 niños que cumplieron con los criterios de elegibilidad. La lesión maculopapular eritematosa acral fue la más común, también el eritema multiforme, el exantema de la varicela y las presentaciones similares a enfermedad de Kawasaki. La duración de las lesiones cutáneas fue de una a dos semanas en 43 %. La biopsia de piel de 18 casos reveló infiltrado linfocítico perivascular, infiltrado paracrino superficial y profundo y vasculitis linfocítica. La RT-PCR fue positiva en 13.8 %. Los marcadores serológicos analizados de virus de herpes simple y parvovirus B19 fueron negativos, y fueron positivos para Mycoplasma pneumoniae en dos de 20 casos. El mecanismo fisiopatológico de las lesiones en piel secundarias a infección por SARS-CoV-2 aún no se ha podido explicar; es probable que se trate de la combinación de uno o más mecanismos complejos, daños cutáneos directos inducidos por el virus, reacciones vasculíticas o lesiones indirectas o secundarias como consecuencia de una reacción inflamatoria sistemática. Se revisaron las publicaciones de 2019 a 2021 en PubMed como fuente principal de búsqueda, para lo cual se utilizaron palabras clave.

Biografía del autor/a

María Claudia Ortega-López, Fundación Hospital Universitario Santa Fe de Bogotá, Departamento de Pediatría, Bogotá

Pediatra - Alergóloga - Inmunóloga Clínica

Especialista en Gestión Aplicada a los Servicios de Salud

Miembro Correspondiente Academia Nacional de Medicina Colombia

 

Citas

Hoang A, Chorath K, Moreira A, Evans M, Burmeister-Morton F, Burmeister F, et al. COVID-19 in 7780 pediatric patients: a systematic review. Lancet. 2020;24:100433. DOI: 10.1016/j.eclinm.2020.100433.

Parri N, Lenge M, Buonsenso D. Children with Covid-19 in pediatric emergency departments in Italy. N Engl J Med. 2020;383(2):187-190. DOI: 10.1056/NEJMc2007617.

Shah S, Akhade K, Ganguly S, Nanda R, Mohapatra E, Goel AK. Cutaneous manifestations associated with COVID-19 in children: a systematic review. J Family Med Prim Care. 2021;10(1):93-101. DOI: 10.21203/rs.3.rs-45314/v1

Khalili M, Iranmanesh B, Mohammadi S, Aflatoonian M. Cutaneous and histopathological features of coronavirus disease 2019 in pediatrics: a review article. Dermatol Ther. 2021;34:e14551. DOI: 10.1111/dth.14554.

Andina D, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, Alonso-Cárdenas JA, Escalada-Pellitero S, et al. Chilblains in children in the setting of COVID-19 pandemic. Pediatr Dermatol. 2020;37(3):406-411. DOI: 10.1111/pde.14215

El-Hachem M, Diociaiuti A, Concato C, Carsetti R, Carnevale C, Degli-Atti MC, et al. A clinical, histopathological and laboratory study of 19 consecutive Italian pediatric patients with chilblain-like lesions: lights and shadows on the relationship with COVID-19 infection. J Eur Acad Dermatol Venereol. 2020;34(11):2620-2629. DOI: 10.1111/jdv.16682

García-Lara G, Linares-González L, Ródenas-Herranz T, Ruiz-Villaverde R. Chilblain-like lesions in pediatrics dermatological outpatients during the COVID-19 outbreak. Dermatol Ther. 2020;33(5):e13516. DOI: 10.1111/dth.13516.

Bouaziz JD, Duong T, Jachiet M, Velter C, Lestang P, Cassius C, et al. Vascular skinsymptoms in COVID-19: a French observational study. J Eur Acad Dermatol Venereol. 2020;34(9):e451-e452. DOI: 10. 38 1111/jdv.16544

Herman A, Peeters C, Verroken A, Tromme I, Tennstedt D, Marot L, et al. Evaluation of chilblains as a manifestation of the covid-19 pandemic. JAMA Dermatol. 2020;156(9):998-1003. DOI: 10.1001/jamadermatol.2020.2368

Roca-Ginés J, Torres-Navarro I, Sánchez-Arráez J, Abril-Pérez C, Sabalza-Baztán O, Pardo-Granell S, et al. Assessment of acute acral lesions in a case series of children and adolescents during the COVID-19 pandemic. JAMA Dermatol. 2020;156:992. DOI: 10.1001/jamadermatol.2020.2340

Tagarro A, Epalza C, Santos M, Sanz-Santaeufemmia J, Oheo E, Moraleda C, et al. Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain. JAMA Pediatr. 2020;e201346. DOI: 10.1001/jamapediatrics.2020.1346

Hadjadj J, Yatim N, Barnabei L, Corneau A, Boussier J, Smith N, et al. Impaired type I interferon activity and exacerbated inflammatory responses in severe COVID-19 patients. Science. 2020;369(6504):718-724. DOI: 10.1126/science.abc6027

Magro CM, Mulvey JJ, Laurence J, Sanders S, Crowson AN, Grossman M, et al. The differing pathophysiologies that underlie COVID-19-associated perniosis and thrombotic retiform purpura: a case series. Br J Dermatol. 2021;184(1):141-150. DOI: 10.1111/bjd.19415

Kolivras A, Dehavay F, Delplace D, Feoli F, Meiers I, Milone L, et al. Coronavirus (COVID-19) infection-induced chilblains: a case report with histopathologic findings. JAAD Case Rep. 2020;6(6):489-492. DOI: 10.1016/j.jdcr.2020.04.011

Colonna C, Monzani NA, Rocchi A et al. Chilblain-like lesions in children following suspected COVID-19 infection. Pediatr Dermatol. 2020;37(3):437-440. DOI: 10.1111/pde.14210. DOI: 10.4049/jimmunol.1402389

Li G, Ju J, Weyand CM, Goronzy JJ. Age-associated failure to adjust type I IFN receptor signaling thresholds after T cell activation. J Immunol. 2015;195(3):865-874. DOI: 10.4049/jimmunol.1402389

Al-Samkari H, Karp-Leaf RS, Dzik WH, Carlson JCT, Fogerty AE, Waheed A, et al. COVID and coagulation: bleeding and thrombotic manifestation of SARS-CoV infection. Blood. 2020;136(4):489-500. DOI: 10.1182/blood.2020006520

Cardot-Leccia N, Hubiche T, Dellamonica J, Burel-Vandenbos F, Passeron T. Pericyte alteration sheds light on microvasculopathy in COVID- 19 infection. Intensive Care Med. 2020;46(9):1777-1778. DOI: 10.1007/s00134-020-06147-7

Colmenero I, Santonja C, Alonso-Riaño M, Niguera-Morel L, Hernández-Martín A, Andina D, et al. SARS- COV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of 7 pediatric patients. Br J Dermatol. 2020;183(4):729-737. DOI: 10.1111/bjd.19327

He L, Mae MA, Sun Y, Pietila R, Nahar K, Vázquez-Liebanas E, et al. Pericyte specific vascular expression of SARS-CoV-2 receptor ACE2 – implications for microvascular inflammation and hypercoagulopathy in COVID-19 patients. Med Hypotheses. 2020;144:110015. DOI: 10.1101/2020.05.11.088500v1

Hamming I, Timens W, Bulthuis MLC, Tely AT, Navis GJ, van-Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631-637. DOI: 10.1002/path.1570

Larenas-Linnemann D, Luna-Pech J, Navarrete-Rodríguez EM, Rodríguez-Pérez N, Arias-Cruz A, Blandón-Vijil MV, et al. Cutaneous manifestations related to COVID-19 immune dysregulation in the pediatric age group. Current Allergy Asthma Rep. 2021;21(2):13. DOI: 10.1007/s11882-020-00986-6

Andina D, Belloni-Fortina A, Bodemer C, Bonifazi E, Chiriac A, Colmenero I, et al. Skin manifestations of COVID-19 in children: part 1. Clin Exp Dermatol. 2021;46(3):444-4450. DOI: 10.1111/ced.14482

Cappel JA, Wetter DA. Clinical characteristics, etiologic associations, laboratory findings, treatment, and proposal of diagnostic criteria of pernio (chilblains) in a series of 104 patients at Mayo Clinic, 2000 to 2011. Mayo Clin Proc. 2014;89:207-215. DOI: 10.1016/j.mayocp.2013.09.020

Piccolo V, Neri I, Filippeschi C, Oranges T, Argenziano G, Batarra VC, et al. Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients. J Eur Acad Dermatol Venereol. 2020;34(7):e291-e293. DOI: 10.1111/jdv.16526

Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J, et al. Clinical and coagulation characteristics of 7 patients with critical COVID-2019 pneumonia and acroischemia. Zhonghua Xue Ye Xue Za Zhi. 2020;41(0):E006. DOI: 10.3760/cma.j.issn.0253-2727.2020.0006

Li T, Lu H, Zhang W. Clinical observation and management of COVID-19 patients. Emerg Microbes Infect. 2020;9:687-690. DOI: 10.1080/22221751.2020.1741327

Grünwald P, Mockenhaupt M, Panzer R, Emmert S. Erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrolysis-diagnosis and treatment. J Dtsch Dermatol Ges. 2020;18:547-553. DOI: 10.1111/ddg.14118

French LE, Prins C. Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. En: Bolognia JL, Jorizzo JL, Schaffer JV, editores. Dermatology. EE. UU.: Elsevier Saunders; 2012.

Sokumbi O, Wetter DA. Clinical features, diagnosis, and treatment of erythema multiforme: a review for the practicing dermatologist. Int J Dermatol. 2012;51(8):889-902. DOI: 10.1111/j.1365-4632.2011.05348.x

Galván-Casas C, Catala A, Carretero-Hernández G, Rodríguez-Jiménez P, Fernández-Nieto D, Rodríguez-Villa R, et al. Classification of the cutaneous manifestations of COVID- 19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020;183:71-77. DOI: 10.1111/bjd.19163

Imbalzano E, Casciaro M, Quartuccio S, Minciullo PL, Cascio A, Calapai G, et al. Association between urticaria and virus infections: a systematic review. Allergy Asthma Proc. 2016;37(1):18-22. DOI: 10.2500/aap.2016.37.3915

Ghahestani SM, Mahmoudi J, Hajebrahimi S, Sioofy-Khojine AB, Salehi-Pourmehr H, Sadeghi-Ghyassi F, et al. Bradykinin as a probable aspect in SARS-Cov-2 scenarios: is bradykinin sneaking out of our sight? Iran J Allergy Asthma Immunol. 2020;19(S1):13-17. DOI: 10.18502/ijaai.v19i(s1.r1).2850

Meini S, Zanichelli A, Sbrojavacca R, Iuri F, Roberts AT, Sufritti C, et al. Understanding the pathophysiology of COVID-19: could the contact system be the key? Front Immunol. 2020;11:2014. DOI: 10.3389/fimmu.2020.02014

Kroumpouzos G. Cutaneous manifestations of COVID-19: An unusual presentation with edematous plaques and pruritic, erythematous papules, and comment on the role of bradykinin storm and its therapeutic implications. Dermatologic Therapy. 2021;e14753. DOI: 10.1111/dth.14753.

Marzano AV, Genovese G. Response to “Reply to ‘Varicella-like exanthem as a specific COVID-19-associated skin manifestation: multicenter case series of 4722 patients’: to consider varicella-like exanthem associated with COVID-19, virus varicella zoster and virus herpes simplex must be ruled out”. J Am Acad Dermatol. 2020;83(3):e255-e256. DOI: 10.1016/j.jaad.2020.05.072

Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395(10239):1771-1778. DOI: 10.1016/S0140-6736(20)31103-X

Toubiana J, Poirault C, Corsia A, Bajolle F, Fourgeaud J, Angoulvant F, et al. Kawasaki-like multisystem inflammatory syndrome in children during the COVID-19 pandemic in Paris, France: prospective observational study. BMJ 2020; 369:2094.

Riphagen S, Gómez X, González-Martínez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet (Lond) Engl 2020; 39: 1607-1608. DOI: 10.1016/S0140-6736(20)31094-1

Grimaud M, Starck J, Levy M, Marais C, Chareyre J, Khraiche D, et al. Acute myocarditis and multisystem inflammatory emerging disease following SARS-CoV-2 infection in critically ill children. Ann Intensive Care. 2020;10:69. DOI: 10.1186/s13613-020-00690-8

Zulfiqar A-A, Lorenzo-Villalba N, Hassler P, Andres E. Immune thrombocytopenic purpura in a patient with Covid-19. N Engl J Med. 2020;382(18):e43. DOI: 10.1056/NEJMc2010472

Joob B, Wiwanitkit V. COVID-19 can present with a rash and be mistaken for Dengue. J Am Acad Dermatol. 2020;82(5):e117. DOI: 10.1016/j.jaad.2020.03.036

Manalo IF, Smith MK, Cheeley J, Jacobs R. A dermatologic manifestation of COVID-19: transient livedo reticularis. J Am Acad Dermatol. 2020;83(2):700. DOI: 10.1016/j.jaad. 2020.04.018.

Jiménez-Cauhe J, Ortega-Quijano D, Prieto-Barrios M, Moreno-Arrones OM, Fernández-Nieto D. Reply to “COVID-19 can present with a rash and be mistaken for dengue”: petechial rash in a patient with COVID-19 infection. J Am Acad Dermatol. 2020;83(2):e141–e142. DOI: 10.1016/j.jaad.2020.04.016

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2022-05-27

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