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| | ===Causes in Alphabetical Order=== |
| | {{Columns-list|3| |
| | *[[dimethyl hydrazine|1,1-Dimethyl hydrazine]] |
| | *[[1,2-Dibromo-3-chloropropane]] |
| | *[[Abdominal distension]] |
| | *[[Accelerated hypertension]] |
| | *[[Acetonitrile]] |
| | *[[Achalasia]] |
| | *[[Acromegaly]] |
| | *[[Acrylonitrile]] |
| | *[[Actinomyces]] |
| | *[[Aortic Dissection|Acute Aortic Dissection]] |
| | *[[Acute Coronary Syndrome]] |
| | *[[Acute intermittent porphyria]] |
| | *[[Acute spinal cord injury]] |
| | *[[Adenosine]] |
| | *[[Affective disorders]] (e.g., [[depression]]) |
| | *[[Air embolism]] |
| | *[[Alveolar hydatid disease]] |
| | *[[Amonafide]] |
| | *[[Amphetamine]] |
| | *[[Ankylosing spondylitis]] |
| | *[[Ankylostomiasis]] |
| | *[[Anthracosis]] |
| | *[[Anxiety|Anxiety disorders]] |
| | *[[Aortic Aneurysm]] |
| | *[[Aortic coarctation]] |
| | *[[Aortic dissection]] |
| | *[[Aortic Stenosis]] |
| | *[[Arryhthmias]] |
| | *[[arsenic|Arsenic dioxide]] |
| | *[[Arsenic trioxide]] |
| | *[[Arsenicals]] |
| | *[[Asbestosis]] |
| | *[[Asthma]] |
| | *[[Atheroma]] |
| | *[[Atopy]] |
| | *[[Atrial flutter]] |
| | *[[Atrial fibrillation]] |
| | *[[Atrial myxoma]] |
| | *[[Autoimmune hemolytic anemia]] |
| | *[[Aztreonam]] |
| | *[[Barotrauma]] |
| | *[[Barret’s esophagus]] |
| | *[[Bechterew's Disease]] |
| | *Bergman syndrome |
| | *Bernheim syndrome |
| | *[[Bland-White-Garland Syndrome]] |
| | *[[Blood transfusion |Blood transfusion complication]] |
| | *[[Bone tumor]] |
| | *[[Bornholm disease]] |
| | *[[Bronchial carcinoma]] |
| | *[[Bronchiectasis]] |
| | *[[Bronchitis]] |
| | *[[Bronchogenic carcinoma]] |
| | *[[Bronchogenic cyst]] |
| | *[[Carbon monoxide]] |
| | *[[Carcinoma]] |
| | *[[Carcinomatous]] |
| | *[[Cardiac syndrome X]] |
| | *[[Cardiomyopathy]] |
| | *[[Cardiopulmonary resuscitation]] |
| | *[[Chagas disease]] |
| | *[[Chest cartilage disorder]] |
| | *[[Chondritis]] |
| | *Chest wall injuries |
| | *[[Chest wall pain syndrome]] |
| | *[[Chinese restaurant syndrome]] |
| | *[[Cholecystitis]] |
| | *[[Cholelithiasis]] |
| | *[[Chronic fatigue syndrome]] |
| | *[[Chronic Obstructive Pulmonary Disease]] ([[COPD]]) |
| | *[[Chronic Stable Angina]] |
| | *[[Cough|Chronic cough]] |
| | *[[Cidofovir]] |
| | *[[Cocaine]] |
| | *Collagen vascular disease with pleuritis |
| | *[[Conn's Syndrome]] |
| | *[[Connective tissue disease]] |
| | *[[Cor pulmonale]] |
| | *[[Coronary artery dissection]] |
| | *[[Coronary Heart Disease]] |
| | *[[Costochondritis]] |
| | *[[Tendinitis|Costocondrial tendinitis]] |
| | *[[Tendinitis|Costosternal tendinitis]] |
| | *[[Cryptococcosis]] |
| | *[[Cytosine arabinoside syndrome]] |
| | *[[Cytarabine]] |
| | *[[Da costa's syndrome]] |
| | *[[Decompression sickness]] |
| | *[[Degenerative changes of cervical spine]] |
| | *[[Desmopressin]] |
| | *[[Dilated cardiomyopathy]] |
| | *[[Diverticulitis]] |
| | *[[Dressler's syndrome | Dressler's syndrome (postpericardiotomy)]] |
| | *[[Migraine medical therapy|Drugs to treat migraine headache]] |
| | *[[Duodenitis]] |
| | *[[Eisenmenger syndrome]] |
| | *[[Empyema]] |
| | *[[Esophageal cyst]] |
| | *[[Esophageal rupture]] |
| | *[[Esophageal spasm]] |
| | *[[Esophagitis]] |
| | *[[Fabricated or induced illness]] |
| | *[[Fabry disease]] |
| | *[[Factitious disorders]] (e.g. [[Münchausen syndrome]]) |
| | *[[Familial hypercholesterolemia]] |
| | *[[Familial mediterranean fever]] |
| | *[[Fibrocystic disease]] |
| | *[[Fibromyalgia]] |
| | *[[Foreign body aspiration]] |
| | *[[Foreign body]] |
| | *[[Fractured rib]] |
| | *[[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=== |
|
| |
|
| ==Overview==
| | *[[Aortic insufficiency]] |
| | | *[[Total anomalous pulmonary venous drainage]] with [[left-to-right shunt]] |
| 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.
| | *[[Atrial myxoma]] |
| | | *[[Atrial septal defect|Atrial septal defect (ASD)]] with [[left-to-right shunt]] |
| == Pathophysiology ==
| | *[[Austin Flint murmur]] |
| | | *[[Bronchial artery|Bronchial collateral circulation]] |
| *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. | | *[[Carey-Coombs murmur]] |
| *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.<ref name="pmid18794463">{{cite journal| author=Lee JS, Kossard S, McGrath MA| title=Lymphocytic thrombophilic arteritis: a newly described medium-sized vessel arteritis of the skin. | journal=Arch Dermatol | year= 2008 | volume= 144 | issue= 9 | pages= 1175-82 | pmid=18794463 | doi=10.1001/archderm.144.9.1175 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18794463 }} </ref> | | *[[Venous hum|Cervical venous hum]] |
| *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."<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> | | *[[Coarctation of the aorta]] |
| *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>
| | *[[Arteriovenous fistula|Coronary or pulmonary arteriovenous malformation]] |
| *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.<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>
| | *[[Hepatic venous hum]] |
| *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>. | | *[[Mammary souffle]] |
| *severe COVID-19 may define a type of catastrophic microvascular injury syndrome mediated by activation of complement pathways and an associated procoagulant state.<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>
| | *[[Mitral stenosis]] |
| | | *[[Patent Ductus Arteriosus| Patent ductus arteriosus (PDA)]] |
| | | *[[Pericarditis|Pericardial knock]] |
| * The viral particles present in the cutaneous blood vessels could lead to a lymphocytic vasculitis.
| | *[[Pulmonary artery stenosis]] |
| * Keratinocytes may be a secondary target after Langerhans cells activation.
| | *[[Pulmonic regurgitation|Pulmonary insufficiency]] |
| * Immune response to infection leads to Langerhans cells activation, resulting in a state of vasodilation and spongiosis.
| | *[[Tricuspid stenosis]] |
| * Microthrombosis and DIC originating in other organs results in livedo reticularis.
| |
| ** Hypoxia-related accumulation of deoxygenated blood in blood vessels.
| |
| ** Vasculopathy with deposition of C5b-9 and C4d.
| |
| | |
| == Histology ==
| |
| *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>.
| |
| **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. | |
| *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. | |
| **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.
| |
| ** papular erythematous exanthema showed edematous dermis with many eosinophils. Cuffs of lymphocytes around blood vessels in a lymphocytic vasculitis.
| |
| **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>
| |
| | |
| == Differentiating COVID-19 Dermatologic manifestations with other Diseases ==
| |
| *COVID-19 can present with a rash and be mistaken for Dengue.<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>. | |
| *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> | |
| | |
| == Epidemiology and Demographics ==
| |
| * The incidence of dermatologic manifestations with COVID-19 infections increases with age; the median age at diagnosis is 53 years. | |
| * Males are more commonly affected than females. | |
| *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>.
| |
| | |
| == Risk Factors ==
| |
| | |
| ==History and Symptoms ==
| |
| * The timing of skin lesions depends on various factors and not really known but 3 days before diagnosis to 13 days after diagnosis.
| |
| *The most common cutaneous manifestation of COVID-19 is a maculopapular exanthem (morbilliform).
| |
| *Majority of lesions were localized on the trunk, however, some patients experienced cutaneous manifestations in the hands and feet.
| |
| *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
| |
| * The other cutaneous manifestations included:<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> | |
| **morbilliform rash as the primary presenting symptoms.<ref name="HuntKoziatek2020">{{cite journal|last1=Hunt|first1=Madison|last2=Koziatek|first2=Christian|title=A Case of COVID-19 Pneumonia in a Young Male with Full Body Rash as a Presenting Symptom|journal=Clinical Practice and Cases in Emergency Medicine|volume=4|issue=2|year=2020|issn=2474252X|doi=10.5811/cpcem.2020.3.47349}}</ref>. | |
| | |
| ** Urticaria.<ref name="pmid32294262">{{cite journal| author=Fernandez-Nieto D, Ortega-Quijano D, Segurado-Miravalles G, Pindado-Ortega C, Prieto-Barrios M, Jimenez-Cauhe J| title=Comment on: Cutaneous manifestations in COVID-19: a first perspective. Safety concerns of clinical images and skin biopsies. | journal=J Eur Acad Dermatol Venereol | year= 2020 | volume= | issue= | pages= | pmid=32294262 | doi=10.1111/jdv.16470 | pmc=7262048 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32294262 }} </ref> | |
| | |
| ** Livedo reticularis lesions | |
| ***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.<ref name="pmidS0190-9622(20)30558-2">{{cite journal| author=Idler DR, Burton MP| title=The pronephroi as the site of presumptive interrenal cells in the hagfish Myxine glutinosa L. | journal=Comp Biochem Physiol A Comp Physiol | year= 1976 | volume= 53 | issue= 1 | pages= 73-7 | pmid=S0190-9622(20)30558-2 | doi=10.1016/s0300-9629(76)80014-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=190 }} </ref>.
| |
| | |
| **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> | |
| | |
| **Acral eruption of erythemato‐violaceous papules and macules, with possible bullous evolution, or digital swelling. | |
| | |
| **Acute acro-ischemia in the child
| |
| ***the presentations of acro-ischemia including finger/toe cyanosis, skin bulla and dry gangrene.<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>.
| |
| ***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>. | |
| | |
| **COVID-19 Toes. | |
| ***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.
| |
| | |
| **chilblain‐like lesions.
| |
| ***The pseudo‐chilblain pattern frequently appears late in the evolution of the COVID‐19 disease.
| |
| ***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.<ref name="pmid32302422">{{cite journal| author=Alramthan A, Aldaraji W| title=Two cases of COVID-19 presenting with a clinical picture resembling chilblains: first report from the Middle East. | journal=Clin Exp Dermatol | year= 2020 | volume= | issue= | pages= | pmid=32302422 | doi=10.1111/ced.14243 | pmc=7264553 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32302422 }} </ref>
| |
| | |
| **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>
| |
| | |
| == 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>
| |
| | |
| **D-dimer, fibrinogen and fibrinogen degradation product (FDP) were significantly elevated in most patients.
| |
| **Prothrombin time was prolonged in 4 patients. D-dimer and FDP levels progressively elevated consistent with COVID-2019 exacerbation.
| |
| **Four patients were diagnosed with disseminated intravascular coagulation (DIC) .
| |
| **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 == | | ===Systolic Heart Murmurs=== |
| 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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| == Treatment ==
| | *[[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]] |
|
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|
| Supportive care for patients is typically the standard protocol because no specific effective antiviral therapies have been identified.<ref name="pmid32091533">{{cite journal| author=Wu Z, McGoogan JM| title=Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. | journal=JAMA | year= 2020 | volume= | issue= | pages= | pmid=32091533 | doi=10.1001/jama.2020.2648 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32091533 }} </ref>
| | ===Continuous Murmurs=== |
| | |
| 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]] |
|
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|
| <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> |
| | |} |