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Periungual desquamation in a Japanese Adult recovering from severe COVID-19

Open AccessPublished:October 16, 2020DOI:https://doi.org/10.1016/j.ijid.2020.10.029

      Highlight

      • Adult patients of severe COVID-19 can cause periungual desquamation like MIS-C.
      • Periungual desquamation may occur in the recovery phase, like pediatric patients.
      • Coronary artery lesions have been reported recovering from MIS-C.
      • Cardiac examination during the recovery phase may be necessary for adult patients.

      Abstract

      We report a case of 50-year-old Japanese male who developed periungual desquamation in hand and feet, during recovery phase of severe COVID-19. As coronary lesions (CALs) have been reported during the recovery phase of severe COVID-19 in children as well as Kawasaki disease, caution may be necessary in adults as well.

      Keywords

      A 50-year-old Japanese man was admitted to our hospital with a 14-day history of fever and sudden dyspnea. The patient was diagnosed with severe coronavirus disease (COVID-19) based on positive test results of RNA polymerase chain reaction for severe acute respiratory syndrome coronavirus. He was started on mechanical ventilation and extracorporeal membrane oxygenation (ECMO). He received ECMO for 23 days and was tracheostomized on hospital day (HD) 37. His general condition improved by HD 54. On HD 61, periungual desquamation appeared on the fingers of left hand (Panel 1A), left palm (Panel 1B), and both feet (Panel 1C). He satisfied the diagnostic criteria for Multisystem Inflammatory Syndrome in Children (MIS-C) other than age (
      • Center for Disease Control and prevention
      Information for Healthcare Providers about Multisystem Inflammatory Syndrome in Children (MIS-C).
      ). There were no other conditions, which have potentially present the periungual desquamation, such as Kawasaki disease (KD) and Toxic Shock Syndrome during hospitalization. His result of bedside echocardiography, electrocardiogram and chest X-ray have revealed no abnormalities until 4 months on admission.
      Severe COVID-19 in children have been reported to present with KD-like symptoms, MIS-C, and some of these have periungual desquamation during the recovery period (
      • Feldstein L.R.
      • Rose E.B.
      • Horwitz S.M.
      • Collins J.P.
      • Newhams M.M.
      • Son M.B.F.
      • Newburger J.W.
      • Kleinman L.C.
      • Heidemann S.M.
      • Martin A.A.
      • Singh A.R.
      • Li S.
      • Tarquinio K.M.
      • Jaggi P.
      • Oster M.E.
      • Zackai S.P.
      • Gillen J.
      • Ratner A.J.
      • Walsh R.F.
      • Fitzgerald J.C.
      • Keenaghan M.A.
      • Alharash H.
      • Doymaz S.
      • Clouser K.N.
      • Giuliano Jr, JS
      • Gupta A
      • Parker RM
      • Maddux AB
      • Havalad V
      • Ramsingh S
      • Bukulmez H
      • Bradford TT
      • Smith LS
      • Tenforde MW
      • Carroll CL
      • Riggs BJ
      • Gertz SJ
      • Daube A
      • Lansell A.
      • Coronado Munoz A.
      • Hobbs CV
      • Marohn KL
      • Halasa NB
      • Patel MM
      • Randolph AG
      Overcoming COVID-19 Investigators, CDC COVID-19 Response Team. Multisystem inflammatory syndrome in U.S. children and adolescents.
      ,
      • Shaigany S.
      • Gnirke M.
      • Guttmann A.
      • Chong H.
      • Meehan S.
      • Raabe V.
      • Louie E.
      • Solitar B.
      • Femia A.
      An adult with Kawasaki-like multisystem inflammatory syndrome associated with COVID-19.
      ). Coronary artery lesions (CALs) have been reported recovering from MIS-C (
      • Dufort E.M.
      • Koumans E.H.
      • Chow E.J.
      • Rosenthal E.M.
      • Muse A.
      • Rowlands J.
      • Barranco M.A.
      • Maxted A.M.
      • Rosenberg E.S.
      • Easton D.
      • Udo T.
      • Kumar J.
      • Pulver W.
      • Smith L.
      • Hutton B.
      • Blog D.
      • Zucker H.
      New York State and Centers for Disease Control and Prevention Multisystem Inflammatory Syndrome in Children Investigation Team. Multisystem inflammatory syndrome in children in New York State.
      ,
      • Feldstein L.R.
      • Rose E.B.
      • Horwitz S.M.
      • Collins J.P.
      • Newhams M.M.
      • Son M.B.F.
      • Newburger J.W.
      • Kleinman L.C.
      • Heidemann S.M.
      • Martin A.A.
      • Singh A.R.
      • Li S.
      • Tarquinio K.M.
      • Jaggi P.
      • Oster M.E.
      • Zackai S.P.
      • Gillen J.
      • Ratner A.J.
      • Walsh R.F.
      • Fitzgerald J.C.
      • Keenaghan M.A.
      • Alharash H.
      • Doymaz S.
      • Clouser K.N.
      • Giuliano Jr, JS
      • Gupta A
      • Parker RM
      • Maddux AB
      • Havalad V
      • Ramsingh S
      • Bukulmez H
      • Bradford TT
      • Smith LS
      • Tenforde MW
      • Carroll CL
      • Riggs BJ
      • Gertz SJ
      • Daube A
      • Lansell A.
      • Coronado Munoz A.
      • Hobbs CV
      • Marohn KL
      • Halasa NB
      • Patel MM
      • Randolph AG
      Overcoming COVID-19 Investigators, CDC COVID-19 Response Team. Multisystem inflammatory syndrome in U.S. children and adolescents.
      ). Therefore, it may be necessary to thoroughly assess adults with severe COVID-19 with periungual desquamation for CALs (Fig. 1).
      Fig. 1
      Fig. 1Periungual desquamation in an adult severe coronavirus disease patient
      Periungual desquamation appeared in the fingernails (Panel 1A) and palm (Panel 1B) of the left hand and in both feet (Panel 1C) in an adult patient with severe COVID-19.

      Funding source

      This research was supported by AMED under Grant Number JP20he0822003.

      Ethical approval

      The patient provided consent for the publication of her clinical case details.

      Conflict of interest

      The authors state that they have no conflict of interest.

      Declaration of interests

      The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

      Acknowledgment

      We thank all the clinical staff at the National Center for Global Health and Medicine for their dedicated clinical practice and patient care.

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