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SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases.
Br J Dermatol. 2020 Jun 20 [Online ahead of print]BJ

Abstract

BACKGROUND

Chilblains ('COVID toes') are being seen with increasing frequency in children and young adults during the COVID-19 pandemic. Detailed histopathological descriptions of COVID-19 chilblains have not been reported, and causality of SARS-CoV-2 has not yet been established.

OBJECTIVES

To describe the histopathological features of COVID-19 chilblains and to explore the presence of SARS-CoV-2 in the tissue.

METHODS

We examined skin biopsies from seven paediatric patients presenting with chilblains during the COVID-19 pandemic. Immunohistochemistry for SARS-CoV-2 was performed in all cases and electron microscopy in one.

RESULTS

Histopathology showed variable degrees of lymphocytic vasculitis ranging from endothelial swelling and endotheliitis to fibrinoid necrosis and thrombosis. Purpura, superficial and deep perivascular lymphocytic inflammation with perieccrine accentuation, oedema, and mild vacuolar interface damage were also seen. SARS-CoV-2 immunohistochemistry was positive in endothelial cells and epithelial cells of eccrine glands. Coronavirus particles were found in the cytoplasm of endothelial cells on electron microscopy.

CONCLUSIONS

Although the clinical and histopathological features were similar to other forms of chilblains, the presence of viral particles in the endothelium and the histological evidence of vascular damage support a causal relation of the lesions with SARS-CoV-2. Endothelial damage induced by the virus could be the key mechanism in the pathogenesis of COVID-19 chilblains and perhaps also in a group of patients severely affected by COVID-19 presenting with features of microangiopathic damage.

Authors+Show Affiliations

Department of Pathology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.Department of Pathology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.Department of Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain.Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.Department of Dermatology, Medical University of Vienna, Vienna, Austria.Department of Pathology, Hospital Universitario 12 de Octubre, Madrid, Spain.Department of Dermatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32562567

Citation

Colmenero, I, et al. "SARS-CoV-2 Endothelial Infection Causes COVID-19 Chilblains: Histopathological, Immunohistochemical and Ultrastructural Study of Seven Paediatric Cases." The British Journal of Dermatology, 2020.
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.
Colmenero, I., Santonja, C., Alonso-Riaño, M., Noguera-Morel, L., Hernández-Martín, A., Andina, D., Wiesner, T., Rodríguez-Peralto, J. L., Requena, L., & Torrelo, A. (2020). SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases. The British Journal of Dermatology. https://doi.org/10.1111/bjd.19327
Colmenero I, et al. SARS-CoV-2 Endothelial Infection Causes COVID-19 Chilblains: Histopathological, Immunohistochemical and Ultrastructural Study of Seven Paediatric Cases. Br J Dermatol. 2020 Jun 20; PubMed PMID: 32562567.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases. AU - Colmenero,I, AU - Santonja,C, AU - Alonso-Riaño,M, AU - Noguera-Morel,L, AU - Hernández-Martín,A, AU - Andina,D, AU - Wiesner,T, AU - Rodríguez-Peralto,J L, AU - Requena,L, AU - Torrelo,A, Y1 - 2020/06/20/ PY - 2020/06/15/accepted PY - 2020/6/21/pubmed PY - 2020/6/21/medline PY - 2020/6/21/entrez JF - The British journal of dermatology JO - Br. J. Dermatol. N2 - BACKGROUND: Chilblains ('COVID toes') are being seen with increasing frequency in children and young adults during the COVID-19 pandemic. Detailed histopathological descriptions of COVID-19 chilblains have not been reported, and causality of SARS-CoV-2 has not yet been established. OBJECTIVES: To describe the histopathological features of COVID-19 chilblains and to explore the presence of SARS-CoV-2 in the tissue. METHODS: We examined skin biopsies from seven paediatric patients presenting with chilblains during the COVID-19 pandemic. Immunohistochemistry for SARS-CoV-2 was performed in all cases and electron microscopy in one. RESULTS: Histopathology showed variable degrees of lymphocytic vasculitis ranging from endothelial swelling and endotheliitis to fibrinoid necrosis and thrombosis. Purpura, superficial and deep perivascular lymphocytic inflammation with perieccrine accentuation, oedema, and mild vacuolar interface damage were also seen. SARS-CoV-2 immunohistochemistry was positive in endothelial cells and epithelial cells of eccrine glands. Coronavirus particles were found in the cytoplasm of endothelial cells on electron microscopy. CONCLUSIONS: Although the clinical and histopathological features were similar to other forms of chilblains, the presence of viral particles in the endothelium and the histological evidence of vascular damage support a causal relation of the lesions with SARS-CoV-2. Endothelial damage induced by the virus could be the key mechanism in the pathogenesis of COVID-19 chilblains and perhaps also in a group of patients severely affected by COVID-19 presenting with features of microangiopathic damage. SN - 1365-2133 UR - https://www.unboundmedicine.com/medline/citation/32562567/SARS-CoV-2_endothelial_infection_causes_COVID-19_chilblains:_histopathological,_immunohistochemical_and_ultraestructural_study_of_7_paediatric_cases L2 - https://doi.org/10.1111/bjd.19327 DB - PRIME DP - Unbound Medicine ER -
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