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| ==Table:1 Location and symptoms of chilblain‐like lesions in children and adults during the pandemic== | | ===Causes in Alphabetical Order=== |
| {| class="wikitable" style="border: 0px; font-size: 90%; margin: 3px;" align="center"
| | {{Columns-list|3| |
| ! rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF| Age/sex}}
| | *[[dimethyl hydrazine|1,1-Dimethyl hydrazine]] |
| ! rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Chilblain location/symptoms}}
| | *[[1,2-Dibromo-3-chloropropane]] |
| ! colspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|COVID‐19 positive}}
| | *[[Abdominal distension]] |
| ! rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Symptoms of COVID‐19,}}
| | *[[Accelerated hypertension]] |
| ! rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Close contact to COVID‐19}}
| | *[[Acetonitrile]] |
| ! colspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Time in weeks during/prior/after COVID‐19}}
| | *[[Achalasia]] |
| |-
| | *[[Acromegaly]] |
| | style="padding: 5px 5px; background: #DCDCDC;" | 15/M
| | *[[Acrylonitrile]] |
| | style="padding: 5px 5px; background: #F5F5F5;" |Toes, heel/ mild itchy
| | *[[Actinomyces]] |
| | | *[[Aortic Dissection|Acute Aortic Dissection]] |
| | | *[[Acute Coronary Syndrome]] |
| * | | *[[Acute intermittent porphyria]] |
| | style="padding: 5px 5px; background: #F5F5F5;" |PCR negative | | *[[Acute spinal cord injury]] |
| | | *[[Adenosine]] |
| Chest X‐ray: bilateral pneumonia
| | *[[Affective disorders]] (e.g., [[depression]]) |
| | style="padding: 5px 5px; background: #F5F5F5;" |Asymptomatic
| | *[[Air embolism]] |
| | | *[[Alveolar hydatid disease]] |
| * | | *[[Amonafide]] |
| | style="padding: 5px 5px; background: #F5F5F5;" |NO
| | *[[Amphetamine]] |
| | style="padding: 5px 5px; background: #F5F5F5;" |Unknown: skin lesions led to the diagnosis of pneumonia, otherwise asymptomatic.
| | *[[Ankylosing spondylitis]] |
| | | *[[Ankylostomiasis]] |
| * | | *[[Anthracosis]] |
| |-
| | *[[Anxiety|Anxiety disorders]] |
| |15/F | | *[[Aortic Aneurysm]] |
| |Finger, heel/ mildly painful when pressing
| | *[[Aortic coarctation]] |
| |Test not done
| | *[[Aortic dissection]] |
| |Nasal congestion, diarrhea
| | *[[Aortic Stenosis]] |
| |Father with COVID‐19, close contact
| | *[[Arryhthmias]] |
| |One week prior mild symptoms and 3 weeks after visiting her father
| | *[[arsenic|Arsenic dioxide]] |
| |-
| | *[[Arsenic trioxide]] |
| |23/F
| | *[[Arsenicals]] |
| |Toes/mild itchy
| | *[[Asbestosis]] |
| |Test not done
| | *[[Asthma]] |
| |Fever, headaches, itchy
| | *[[Atheroma]] |
| |Lives in high risk area
| | *[[Atopy]] |
| |3 weeks prior
| | *[[Atrial flutter]] |
| |-
| | *[[Atrial fibrillation]] |
| |44/M
| | *[[Atrial myxoma]] |
| |Toe/mildly painful when pressing
| | *[[Autoimmune hemolytic anemia]] |
| |Test not done
| | *[[Aztreonam]] |
| |Sore throat
| | *[[Barotrauma]] |
| |Unknown
| | *[[Barret’s esophagus]] |
| |Sore throat 10 days earlier
| | *[[Bechterew's Disease]] |
| |-
| | *Bergman syndrome |
| |91/M
| | *Bernheim syndrome |
| |Toe
| | *[[Bland-White-Garland Syndrome]] |
| |Yes (requiring hospitalization)
| | *[[Blood transfusion |Blood transfusion complication]] |
| |Recovered | | *[[Bone tumor]] |
| | | | *[[Bornholm disease]] |
| |After 3 weeks of COVID‐19 confirmed | | *[[Bronchial carcinoma]] |
| |-
| | *[[Bronchiectasis]] |
| |24/F
| | *[[Bronchitis]] |
| |Toes/painful when pressing
| | *[[Bronchogenic carcinoma]] |
| |Yes
| | *[[Bronchogenic cyst]] |
| |
| | *[[Carbon monoxide]] |
| |
| | *[[Carcinoma]] |
| |After infection | | *[[Carcinomatous]] |
| |} | | *[[Cardiac syndrome X]] |
| | | *[[Cardiomyopathy]] |
| CVS
| | *[[Cardiopulmonary resuscitation]] |
| | | *[[Chagas disease]] |
| __NOTOC__
| | *[[Chest cartilage disorder]] |
| {{WikiDoc scholar program}}
| | *[[Chondritis]] |
| | | *Chest wall injuries |
| ==Overview==
| | *[[Chest wall pain syndrome]] |
| | | *[[Chinese restaurant syndrome]] |
| COVID-19 infections is caused by the novel coronavirus or also known as SARS-2 virus. The disease is believed to incline towards respiratory organs due to the high expression of ACE receptors. However, skin rashes have been uncommonly described in patients with COVID-19 infection. Dermatologic manifestations of COVID-19 include an erythematous exanthem (including a lacy pattern and a petechial, dengue-like rash), livedo reticularis, cutaneous vasculitis acute urticaria, chickenpox-like blisters.
| | *[[Cholecystitis]] |
| | | *[[Cholelithiasis]] |
| == Pathophysiology ==
| | *[[Chronic fatigue syndrome]] |
| | | *[[Chronic Obstructive Pulmonary Disease]] ([[COPD]]) |
| *The exact mechanisms of COVID-19 induced cutaneous manifestations are not yet well known,however skin pathologies in which a virus is implicated, various types of manifestations in the cutaneous district involved. Frequently, it is indicating a hematogenous spreading of the virus through the cutaneous vascular system. | | *[[Chronic Stable Angina]] |
| *The next step could create activation of the immune system with mobilization of lymphocytes and Langerhans cells patrolling that run through the skin-lymph node path. If the virus swarm induces the creation of immune complexes, this can lead CD4 + T helper lymphocytes to produce cytokines, like IL-1, IFN-γ, and TNF-α, and to recruit eosinophils, CD8+ cytotoxic T cells, B cells and natural killer (NK) cells leading a lymphocytic thrombophilic arteritis. | | *[[Cough|Chronic cough]] |
| *Sepsis or severe viral infections could activate the cytokine cascade inducing a CID phenomenon. Just like we observed in the skin and in the lung and kidneys of COVID + patients. However, there are underhanded viral attacks that probably induce a modification in the structure of the keratinocyte, which is destroyed by the cytotoxic lymphocytes, almost resembling the well- known ancient trick of the "Trojan horse." | | *[[Cidofovir]] |
| *HSV is suspected of provoking stimulation of immunopathological mechanisms in erythema multiforme. The herpes virus could play a role in autoimmune cross-reactivity, triggering the keratinocyte that activates IL-1, IFN-γ, and TNF-α, recruiting cytotoxic and NK cells that target the keratinocytes itself.Lucchese A. From HSV infection to erythema multiforme through autoimmune crossreactivity.<ref name="pmid32381428">{{cite journal| author=Gianotti R, Zerbi P, Dodiuk-Gad RP| title=Clinical and histopathological study of skin dermatoses in patients affected by COVID-19 infection in the Northern part of Italy. | journal=J Dermatol Sci | year= 2020 | volume= | issue= | pages= | pmid=32381428 | doi=10.1016/j.jdermsci.2020.04.007 | pmc=7190511 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32381428 }} </ref> | | *[[Cocaine]] |
| *Histopathological examination of lung biopsy of COVID + pneumonia indicates a severe damage of the alveolar epithelial cell floating in the alveolar space just like in bullous severe erythema multiforme in which ballooning keratinocytes detach from the spinous layer. | | *Collagen vascular disease with pleuritis |
| *Degeneration and necrosis of parenchymal cells and formation of hyaline thrombi in small vessels were observed in lung and other organs.<ref name="pmid32172546">{{cite journal| author=Yao XH, Li TY, He ZC, Ping YF, Liu HW, Yu SC | display-authors=etal| title=[A pathological report of three COVID-19 cases by minimal invasive autopsies]. | journal=Zhonghua Bing Li Xue Za Zhi | year= 2020 | volume= 49 | issue= 5 | pages= 411-417 | pmid=32172546 | doi=10.3760/cma.j.cn112151-20200312-00193 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32172546 }} </ref>. | | *[[Conn's Syndrome]] |
| *severe COVID-19 may define a type of catastrophic microvascular injury syndrome mediated by activation of complement pathways and an associated procoagulant state. | | *[[Connective tissue disease]] |
| | | *[[Cor pulmonale]] |
| | | *[[Coronary artery dissection]] |
| * The viral particles present in the cutaneous blood vessels could lead to a lymphocytic vasculitis. | | *[[Coronary Heart Disease]] |
| * Keratinocytes may be a secondary target after Langerhans cells activation. | | *[[Costochondritis]] |
| * Immune response to infection leads to Langerhans cells activation, resulting in a state of vasodilation and spongiosis. | | *[[Tendinitis|Costocondrial tendinitis]] |
| * Microthrombosis and DIC originating in other organs results in livedo reticularis. | | *[[Tendinitis|Costosternal tendinitis]] |
| ** Hypoxia-related accumulation of deoxygenated blood in blood vessels. | | *[[Cryptococcosis]] |
| ** Vasculopathy with deposition of C5b-9 and C4d. | | *[[Cytosine arabinoside syndrome]] |
| | | *[[Cytarabine]] |
| == Histology ==
| | *[[Da costa's syndrome]] |
| *histopathological studies and PCR investigation on skin biopsies are necessary to clarify the close relationship between skin and SARS-CoV-2 infection,however histopathological study of skin dermatoses in patients affected by COVID-19 infection in the Northern part of Italy showed:<ref name="pmid32381428">{{cite journal| author=Gianotti R, Zerbi P, Dodiuk-Gad RP| title=Clinical and histopathological study of skin dermatoses in patients affected by COVID-19 infection in the Northern part of Italy. | journal=J Dermatol Sci | year= 2020 | volume= | issue= | pages= | pmid=32381428 | doi=10.1016/j.jdermsci.2020.04.007 | pmc=7190511 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32381428 }} </ref>. | | *[[Decompression sickness]] |
| **diffuse maculopapular eruption involving only the trunk, clinically suggestive for Grover disease showed, in addition to the classic dyskeratotic cells, ballooning multinucleated cells and sparse necrotic keratinocytes with lymphocytic satellitosis. | | *[[Degenerative changes of cervical spine]] |
| *punch biopsy showed in the upper dermis diffuse telangiectatic small blood vessels with no other peculiar features, and In a second punch nests of Langerhans cells within the epidermis was the unique clue in this stage. | | *[[Desmopressin]] |
| **maculo-papulo-vesicular rash histological findings showed a perivascular spongiotic dermatitis with exocytosis along with a large nest of Langerhans cells and a dense perivascular lymphocytic infiltration eosinophilic rich around the swollen blood vessels with extravasated erythrocytes. | | *[[Dilated cardiomyopathy]] |
| ** papular erythematous exanthema showed edematous dermis with many eosinophils. Cuffs of lymphocytes around blood vessels in a lymphocytic vasculitis. | | *[[Diverticulitis]] |
| **The purpuric skin lesions showed a pauci-inflammatory thrombogenic vasculopathy, with deposition of C5b-9 and C4d in both grossly involved and normally-appearing skin. In addition, there was co-localization of COVID-19 spike glycoproteins with C4d and C5b-9 in the interalveolar septa and the cutaneous microvasculature.<ref name="pmid32299776">{{cite journal| author=Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J | display-authors=etal| title=Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. | journal=Transl Res | year= 2020 | volume= 220 | issue= | pages= 1-13 | pmid=32299776 | doi=10.1016/j.trsl.2020.04.007 | pmc=7158248 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32299776 }} </ref> | | *[[Dressler's syndrome | Dressler's syndrome (postpericardiotomy)]] |
| | | *[[Migraine medical therapy|Drugs to treat migraine headache]] |
| == Differentiating COVID-19 Dermatologic manifestations with other Diseases ==
| | *[[Duodenitis]] |
| *COVID-19 can present with a rash and be mistaken for Dengue.. | | *[[Eisenmenger syndrome]] |
| *maculopapular eruption involving only the trunk, clinically suggestive for Grover disease.<ref name="pmid32381428">{{cite journal| author=Gianotti R, Zerbi P, Dodiuk-Gad RP| title=Clinical and histopathological study of skin dermatoses in patients affected by COVID-19 infection in the Northern part of Italy. | journal=J Dermatol Sci | year= 2020 | volume= | issue= | pages= | pmid=32381428 | doi=10.1016/j.jdermsci.2020.04.007 | pmc=7190511 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32381428 }} </ref> | | *[[Empyema]] |
| | | *[[Esophageal cyst]] |
| == Epidemiology and Demographics ==
| | *[[Esophageal rupture]] |
| * The incidence of dermatologic manifestations with COVID-19 infections increases with age; the median age at diagnosis is 53 years. | | *[[Esophageal spasm]] |
| * Males are more commonly affected than females. | | *[[Esophagitis]] |
| *In Spain,Most of the patients were children (median 13 years) and young adults (median 31, average 36, range 18–91 years old).<ref name="pmid32381428">{{cite journal| author=Gianotti R, Zerbi P, Dodiuk-Gad RP| title=Clinical and histopathological study of skin dermatoses in patients affected by COVID-19 infection in the Northern part of Italy. | journal=J Dermatol Sci | year= 2020 | volume= | issue= | pages= | pmid=32381428 | doi=10.1016/j.jdermsci.2020.04.007 | pmc=7190511 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32381428 }} </ref>. | | *[[Fabricated or induced illness]] |
| | | *[[Fabry disease]] |
| == Risk Factors ==
| | *[[Factitious disorders]] (e.g. [[Münchausen syndrome]]) |
| | | *[[Familial hypercholesterolemia]] |
| ==History and Symptoms ==
| | *[[Familial mediterranean fever]] |
| * The timing of skin lesions depends on various factors and not really known but 3 days before diagnosis to 13 days after diagnosis. | | *[[Fibrocystic disease]] |
| *The most common cutaneous manifestation of COVID-19 is a maculopapular exanthem (morbilliform). | | *[[Fibromyalgia]] |
| *Majority of lesions were localized on the trunk, however, some patients experienced cutaneous manifestations in the hands and feet. | | *[[Foreign body aspiration]] |
| *Skin lesion development occurred before the onset of respiratory symptoms or COVID-19 diagnosis in some of the patients , and lesions spontaneously healed in all patients within 10 days | | *[[Foreign body]] |
| * The other cutaneous manifestations included: | | *[[Fractured rib]] |
| **morbilliform rash as the primary presenting symptoms.. | | *[[Functional disorders]] |
| | *[[Gallbladder disease]] |
| | *[[Gas]] |
| | *[[Gastritis]] |
| | *[[Gastroesophageal reflux]] ([[GERD]]) |
| | *[[Gemeprost]] |
| | *[[Glatiramer acetate]] |
| | *[[Glycogenosis]] |
| | *[[Goodpasture's syndrome]] |
| | *[[Gynecomastia]] |
| | *[[Heart attack]] |
| | *[[Syphilitic aortitis|Heller-Dohle disease]] |
| | *[[Hemothorax]] |
| | *[[Hepatitis]] |
| | *[[Herpes zoster]] |
| | *[[Hiatus Hernia]] |
| | *[[Histoplasmosis]] |
| | *[[HIV|HIV infection]] |
| | *[[Munchausen syndrome|Hospital addiction syndrome]] |
| | *[[Hyperthyroidism]] |
| | *[[Hypertrophic cardiomyopathy]] |
| | *[[Hyperventilation]] |
| | *[[Hyperventilation syndrome]] |
| | *[[Hypochondria]] |
| | *[[Hypothyroidism]] |
| | *[[Idarubicin hydrochloride]] |
| | *[[Idiopathic]] |
| | *[[Impacted stone]] |
| | *[[Infection]] |
| | *[[Infliximab]] |
| | *[[Irritable bowel disease]] |
| | *[[Intercostal muscle spasm]] |
| | *[[Intercostal neuralgia]] |
| | *[[Interferon gamma]] |
| | *[[Interstitial fibrosis]] |
| | *[[Interstitial lung disease]] |
| | *[[Iodixanol]] |
| | *[[Isolated coronary artery anomalies]] |
| | *[[Ischemic heart disease]] |
| | *[[Ivacaftor]] |
| | *[[Kawasaki disease]] |
| | *[[Langerhans' cell histiocytosis]] |
| | *[[Laryngotracheitis]] |
| | *[[Lassa fever]] |
| | *[[Lead]] |
| | *[[Left ventricular hypertrophy]] |
| | *[[Legionnaires' disease]] |
| | *[[Liver abscess]] |
| | *[[Liver cancer]] |
| | *[[Lung Abscess]] |
| | *[[Lung Cancer]] |
| | *[[Lymphangiomyomatosis]] |
| | *[[Lymphoma]] |
| | *[[Mallory-Weiss Syndrome]] |
| | *[[Mastalgia]] |
| | *[[Mediastinal tumor]] |
| | *[[Mediastinitis]] |
| | *[[Mesothelioma]] |
| | *[[Mesothelioma]] |
| | *[[Metastatic tumor]] |
| | *[[Mitral valve prolapse]] |
| | *[[Mondor's disease]] |
| | *[[Musculoskeletal pain ]] |
| | *[[Muscle strain or spasm]] |
| | *[[Mycoplasma pneumonia]] |
| | *[[Myocarditis]] |
| | *[[Myocardial infarction]] |
| | *[[Myofascial pain syndrome|Myofascial pain]] |
| | *[[Myostitis]] |
| | *[[Naratriptan]] |
| | *[[Nabilone]] |
| | *[[Neoplasm]] |
| | *[[Neuritis]] |
| | *[[Neurofibroma]] |
| | *[[non ST elevation MI]] |
| | *[[nutcracker's esophagus|Nutcracker's esophagus]] |
| | *[[Nylidrin]] |
| | *[[Oprelvekin]] |
| | *[[Pancreatitis]] |
| | *[[Panic attack]] |
| | *[[Pectus excavatum]] |
| | *[[Peptic ulcer disease]] |
| | *[[Perforated ulcer]] |
| | *[[Pericardial effusion]] |
| | *[[tamponade|Pericardial tamponade]] |
| | *[[Pericarditis]] |
| | *[[Periostitis]] |
| | *[[Peritonitis]] |
| | *[[Pheochromocytoma]] |
| | *[[Pleural Effusion]] |
| | *[[Pleural empyema]] |
| | *[[Pleural fibroma]] |
| | *[[Pleurisy]] |
| | *[[Pleuritis]] |
| | *[[Pleurodynia]] |
| | *[[Plummer-Vinson Syndrome]] |
| | *[[Pneumoconiosis]] |
| | *[[Pneumomediastinum]] |
| | *[[Pneumonia]] |
| | *[[Pneumoperitoneum]] |
| | *[[Pneumothorax]] |
| | *[[Porfimer]] |
| | *[[Pott's Disease]] |
| | *[[Precordial catch syndrome]] |
| | *[[Pregnancy ]] |
| | *[[Prinzmetal angina]] |
| | *[[Mitral valve prolapse|Prolapsed mitral cusp]] |
| | *[[Psychiatric]] |
| | *[[Pulmonary embolism]] |
| | *[[Pulmonary hypertension]] |
| | *[[Pulmonary infarction]] |
| | *[[Syphilis|Quaternary syphilis]] |
| | *[[Radiculitis]] |
| | *[[Recurrent hereditary polyserositis]] |
| | *[[Regadenoson]] |
| | *[[Respiratory alkalosis]] |
| | *[[Retropharyngeal abscess]] |
| | *[[Pain|Rib pain]] |
| | *[[Rizatriptan]] |
| | *[[Rumination disorder]] |
| | *[[SAPHO syndrome]] |
| | *[[Sarcoidosis]] |
| | *[[Sargramostim]] |
| | *[[Exertion|Severe exertion]] |
| | *[[Shingles]] |
| | *[[bursitis|Shoulder bursitis]] |
| | *[[tendinitis|Shoulder tendinitis]] |
| | *[[Sickle cell anemia]] |
| | *[[Silicosis]] |
| | *[[SLE]] |
| | *[[Tietze's Syndrome|Slipping rib syndrome]] |
| | *[[tumor|Soft tissue sarcoma or tumor]] |
| | *[[Somatization disorder]] |
| | *[[Somatoform disorder]]s |
| | *[[Splenomegaly|Splenic enlargement]] |
| | *[[Degenerative disc disease|Spinal arthritis]] |
| | *[[Spinal cord compression ]] |
| | *[[Spinal disease]] |
| | *[[Spondylosis|Spinal spondylosis]] |
| | *[[Spinal cord tumor|Spinal tumor]] |
| | *[[Splenic infarction]] |
| | *[[Ruptured spleen|Spleen rupture]] |
| | *[[ST elevation MI]] |
| | *[[Stable angina]] |
| | *[[Stress]] |
| | *[[Arthritis|Sternoclavicular arthritis]] |
| | *[[Strain (injury)|Strain of pectoralis muscle]] |
| | *[[Stress cardiomyopathy]] |
| | *[[Subdiaphragmatic abscess]] |
| | *[[Subphrenic abscess]] |
| | *[[Sumatriptan]] |
| | *[[Tabes dorsalis]] |
| | *[[Tachyarrhythmias]] |
| | *[[Takotsubos cardiomyopathy]] |
| | *[[pneumothorax|Tension pneumothorax]] |
| | *[[Thallium]] |
| | *[[Thelarche]] |
| | *[[Thoracic Outlet Syndrome]] |
| | *[[Thought disorder]]s (e.g., [[Delusion|fixed delusions]]) |
| | *[[Thymoma]] |
| | *[[Tiagabine]] |
| | *[[Tietze's syndrome]] |
| | *[[Tracheitis]] |
| | *[[Tracheoesophageal abscess]] |
| | *[[Trauma]] |
| | *[[Trichinella spiralis]] |
| | *[[Tuberculosis]] |
| | *[[Tumor]] |
| | *[[unstable angina]] |
| | *[[Variant angina ]] |
| | *[[Varicella-zoster virus]] |
| | *[[back pain|Vertebrogenic thoracic pain]] |
| | *[[Wegner's Granulomatosis]] |
| | *[[Whipple's Disease]] |
| | *[[Xiphodynia]] |
| | *[[Zolmitriptan]] |
| | }} |
| | ==Causes== |
| | ===Diastolic Heart Murmurs=== |
|
| |
|
| ** Urticaria. | | *[[Aortic insufficiency]] |
| | *[[Total anomalous pulmonary venous drainage]] with [[left-to-right shunt]] |
| | *[[Atrial myxoma]] |
| | *[[Atrial septal defect|Atrial septal defect (ASD)]] with [[left-to-right shunt]] |
| | *[[Austin Flint murmur]] |
| | *[[Bronchial artery|Bronchial collateral circulation]] |
| | *[[Carey-Coombs murmur]] |
| | *[[Venous hum|Cervical venous hum]] |
| | *[[Coarctation of the aorta]] |
| | *[[Arteriovenous fistula|Coronary or pulmonary arteriovenous malformation]] |
| | *[[Hepatic venous hum]] |
| | *[[Mammary souffle]] |
| | *[[Mitral stenosis]] |
| | *[[Patent Ductus Arteriosus| Patent ductus arteriosus (PDA)]] |
| | *[[Pericarditis|Pericardial knock]] |
| | *[[Pulmonary artery stenosis]] |
| | *[[Pulmonic regurgitation|Pulmonary insufficiency]] |
| | *[[Tricuspid stenosis]] |
|
| |
|
| ** Livedo reticularis lesions
| | ===Systolic Heart Murmurs=== |
| ***Livedo reticularis is caused by conditions, including disseminated intravascular coagulation (DIC), that reduce blood flow through the cutaneous microvasculature system leading to deoxygenated blood accumulation in the venous plexus..
| |
|
| |
|
| **petechial skin rash.<ref name="pmid32213305">{{cite journal| author=Joob B, Wiwanitkit V| title=COVID-19 can present with a rash and be mistaken for dengue. | journal=J Am Acad Dermatol | year= 2020 | volume= 82 | issue= 5 | pages= e177 | pmid=32213305 | doi=10.1016/j.jaad.2020.03.036 | pmc=7156802 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32213305 }} </ref> | | *[[Aortic sclerosis]] |
| | *[[Aortic stenosis]] |
| | *[[Atrial septal defect]] |
| | *[[Bicuspid aortic valve]] |
| | *[[Venous hum|Cervical venous hum]] |
| | *[[Coarctation of the aorta]] |
| | *[[Arteriovenous fistula|Coronary or pulmonary arteriovenous malformation]] |
| | *[[Endocarditis]] |
| | *[[Hepatic venous hum]] |
| | *[[Hyperthyroidism]] |
| | *[[Innocent murmur]] |
| | *[[Left ventricular outflow tract obstruction]] |
| | *[[Mammary souffle]] |
| | *[[Mitral insufficiency]] |
| | *[[Mitral valve prolapse]] |
| | *[[Papillary muscle dysfunction]] |
| | *[[Patent ductus arteriosus|Patent ductus arteriosus PDA)]] |
| | *[[Pericardial friction rub]]s |
| | *[[Pulmonary artery stenosis|Peripheral pulmonary artery stenosis]] |
| | *[[Artificial heart valve|Prosthetic valve]] |
| | *[[Pulmonary artery stenosis]] |
| | *[[Pulmonic stenosis|Pulmonic outflow obstruction]] |
| | *[[Still's murmur]] |
| | *[[Tricuspid insufficiency]] |
| | *[[Ventricular septal defect]] |
|
| |
|
| **Acral eruption of erythemato‐violaceous papules and macules, with possible bullous evolution, or digital swelling.
| | ===Continuous Murmurs=== |
| | |
| **Acute acro-ischemia in the child
| |
| ***the presentations of acro-ischemia including finger/toe cyanosis, skin bulla and dry gangrene..
| |
| ***they could be the expression of secondary microthrombosis due to endothelial damage and vascular disorders.<ref name="pmid32447934">{{cite journal| author=Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J | display-authors=etal| title=[Clinical and coagulation characteristics in 7 patients with critical COVID-2019 pneumonia and acro-ischemia]. | journal=Zhonghua Xue Ye Xue Za Zhi | year= 2020 | volume= 41 | issue= 4 | pages= 302-307 | pmid=32447934 | doi=10.3760/cma.j.issn.0253-2727.2020.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32447934 }} </ref>.
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| | |
| **COVID-19 Toes.
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| ***similar to the type of cold related changes we have seen in the feet of people for many years, but often occurring in places where the conditions are not cold and damp. These seem to happen more commonly in younger patients.
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| **chilblain‐like lesions.
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| ***The pseudo‐chilblain pattern frequently appears late in the evolution of the COVID‐19 disease.
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| ***the lesion was red–purple papules on the dorsal aspect of the fingers on both hands and diffused erythema in the subungual area of thumb.
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| | |
| **erythema multiforme-like lesions that might be another pattern of exanthem associated with COVID-19 infection.Further studies are needed to evaluate whether these lesions are associated with the virus, the drug intake or any other conditions.<ref name="pmid32385858">{{cite journal| author=Jimenez-Cauhe J, Ortega-Quijano D, Carretero-Barrio I, Suarez-Valle A, Saceda-Corralo D, Moreno-Garcia Del Real C | display-authors=etal| title=Erythema multiforme-like eruption in patients with COVID-19 infection: clinical and histological findings. | journal=Clin Exp Dermatol | year= 2020 | volume= | issue= | pages= | pmid=32385858 | doi=10.1111/ced.14281 | pmc=7272969 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32385858 }} </ref>
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| | |
| == Laboratory Findings ==
| |
| Acute acro-ischemia in the child lab results:<ref name="pmid32447934">{{cite journal| author=Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J | display-authors=etal| title=[Clinical and coagulation characteristics in 7 patients with critical COVID-2019 pneumonia and acro-ischemia]. | journal=Zhonghua Xue Ye Xue Za Zhi | year= 2020 | volume= 41 | issue= 4 | pages= 302-307 | pmid=32447934 | doi=10.3760/cma.j.issn.0253-2727.2020.008 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32447934 }} </ref>
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| | |
| **D-dimer, fibrinogen and fibrinogen degradation product (FDP) were significantly elevated in most patients.
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| **Prothrombin time was prolonged in 4 patients. D-dimer and FDP levels progressively elevated consistent with COVID-2019 exacerbation.
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| **Four patients were diagnosed with disseminated intravascular coagulation (DIC) .
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| **Low molecular weight heparin (LMWH) was administrated in 6 patients, which reduced D-dimer and FDP rather than improved clinical symptoms.
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| | |
| == Diagnostic studies ==
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| | |
| == Prognosis ==
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| The skin lesions are initially reddish and papular resembling chilblains. Subsequently, in the span of approximately 1 week they become more purpuric and flattened. Finally, they seem to resolve by themselves without requiring any treatment.
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| | |
| == Treatment ==
| |
| | |
| Supportive care for patients is typically the standard protocol because no specific effective antiviral therapies have been identified.
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| | |
| The skin lesions are initially reddish and papular resembling chilblains. Subsequently, in the span of approximately 1 week they become more purpuric and flattened. Finally, they seem to resolve by themselves without requiring any treatment.<ref name="pmid32329897">{{cite journal| author=Landa N, Mendieta-Eckert M, Fonda-Pascual P, Aguirre T| title=Chilblain-like lesions on feet and hands during the COVID-19 Pandemic. | journal=Int J Dermatol | year= 2020 | volume= 59 | issue= 6 | pages= 739-743 | pmid=32329897 | doi=10.1111/ijd.14937 | pmc=7264591 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32329897 }} </ref>
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|
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|
| | *[[Aortic coarctation]] |
| | *[[Aortic insufficiency]] |
| | *[[Aortic stenosis]] |
| | *[[Coronary artery fistula]] |
| | *[[Mammary souffle]] |
| | *[[Pneumomediastinum|Mediastinal air dissection]] |
| | *[[Patent ductus arteriosus]] |
| | *[[Pericardial friction rub]] |
| | *[[Pulmonary arteriovenous fistula]] |
| | *[[Sinus of Valsalva|Ruptured sinus of Valsalva]] |
| | *[[Venous hum]] |
|
| |
|
| <br /> | | <br /> |
| *
| | {| class="wikitable" border="1" |
| | | ! style="width: 300px;background:#4479BA" |{{fontcolor|#FFF| SYSTOLIC MURMUR}}!! style="width: 300px;background:#4479BA" |{{fontcolor|#FFF| DIASTOLIC MURMUR}}!! style="width: 300px;background:#4479BA" |{{fontcolor|#FFF| Continuous Murmur}} |
| ==References== | | |- |
| <references /> | | |❑ '''[[Mitral regurgitation resident survival guide#Treatment of Acute Mitral Regurgitation|Acute Mitral Regurgitation]]''' <br> ❑ '''[[Mitral regurgitation resident survival guide#Treatment of chronic Mitral Regurgitation|chronic Mitral Regurgitation]]'''<br> ❑ '''[[Aortic stenosis resident survival guide#Treatment|Aortic stenosis]]'''<br> ❑ '''[[Hypertrophic cardiomyopathy resident survival guide#Treatment|HOCM]]'''<br> |
| | |❑ '''[[Aortic regurgitation resident survival guide#Treatment|Aortic regurgitation]]'''<br> ❑ '''[[Mitral stenosis resident survival guide#Treatment|Mitral stenosis]]'''<br> |
| | |❑ '''[[PDA#treatment ]]''' <br> |
| | |} |