Abstract
The novel coronavirus (SARS-CoV-2) pandemic continues to surge across the globe with no signs of slowing down. SARS-CoV-2 infections (Covid-19) affect multiple organ systems with varied clinical presentation. Common clinical respiratory signs and symptoms associated with Covid-19 include fever, cough and shortness of breath. However, clinicians should be aware that cutaneous rashes could be the only clinical sign and symptom. Recognition of cutaneous rashes without other symptoms should be considered as part of the clinical presentation of Covid-19 infection and could easily be overlooked. Prompt recognition could lead to early clinical testing for the coronavirus and appropriate management to mitigate community spread of the virus.
Highlights
The primary target organ of the severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the most commonly reported symptoms reported by patients who are infected with SARS-CoV-2 involve the respiratory tract
Entry of the coronavirus into human cells occurs through the interaction of a receptor-binding domain on the viral spike glycoprotein ectodomain with the Angiotensin-Converting Enzyme 2 (ACE2) receptor [12,13]
The mechanism for cutaneous lesions is unknown, high levels of ACE2 receptors in the skin may explain the dermatologic manifestations of COVID-19 infection [14]
Summary
The primary target organ of the severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the most commonly reported symptoms reported by patients who are infected with SARS-CoV-2 involve the respiratory tract. Reports of isolated cutaneous lesions have recently been reported, such as erythematous rash, confluent urticarial wheals, purpuric rash, chickenpox-like vesicles, petechiae rash, transient livedo reticularis and red papules on fingers [7,8,9] Such dermatologic manifestations could be the only initial presenting sign and symptom and should be considered as part of the clinical presentation in the diagnosis of SARS-CoV-2 [8,10]. This case report describes a patient who presented with a cutaneous rash on the right lower extremity without other symptoms three weeks prior to hospitalization for management of severe Covid-19.
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