New-Onset Bullous Pemphigoid in a COVID-19 Patient

Natalie Olson,Angela Delano,David Eckhardt,Sergio A Cuevas Covarrubias

doi:10.1155/2021/5575111

Abstract

This manuscript presents a report of bullous pemphigoid rash associated with COVID-19 for the first time. The objective of this manuscript is to present a unique dermatological case in the setting of a COVID-19-positive infection to further recognize the virus symptomatology. A 37-year-old female with a past medical history of class III obesity, type II diabetes mellitus, and hypertension presented to the emergency department in September 2020 with inpatient and outpatient follow-up through to November 2020. The patient denied any personal or family history of skin disorders. The patient tested positive for COVID-19 prior to hospitalization and presented to the hospital with severe, persistent, pruritic rash meeting dermatopathological, serologic, and clinical criteria for bullous pemphigoid diagnosis. Histopathology H&E punch biopsy from her left flexor wrist demonstrated epidermal keratinocyte necrosis, subepidermal vesiculation with eosinophils, gossamer stranding of the papillary dermis, and subepidermal edema. Direct immunofluorescence punch biopsy from her left flexor wrist demonstrated strong linear IgG staining at the dermoepidermal junction, with weaker and focal linear C3 staining. Antigen-specific serology was consistent with bullous pemphigoid. There was no previously reported cutaneous association of COVID-19 infection with bullous pemphigoid making this case an important addition to the body of evidence helping to identify bullous pemphigoid in the setting of viral infection.

Highlights

In 2019, a (Novel) coronavirus emerged in Wuhan, China. e virus has been found to cause severe pneumonia and has affected 35 million people, resulting in 1.5 million deaths worldwide since its emergence
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a single-stranded RNA virus that spreads via aerosolized droplets and enters host cells through the angiotensinconverting enzyme 2 (ACE2) receptor [1]
It is widely accepted that high ACE2 expression has been found in the type II alveolar cells and secretory cells of the lungs; it has been suggested that ACE2 receptors are found in the small intestinal epithelium, oral epithelial cells, endothelial cells, and keratinocytes in the skin [1]

Summary

Introduction

In 2019, a (Novel) coronavirus emerged in Wuhan, China. e virus has been found to cause severe pneumonia and has affected 35 million people, resulting in 1.5 million deaths worldwide since its emergence. We present a report on a unique dermatological presentation of bullous pemphigoid (BP) in a known COVID-19-positive patient. 3. Discussion is submission presents a review of the current literature related to cutaneous manifestations of SARS-CoV-2 and the case of a woman who tested positive for COVID-19 after she noticed an annular, bullous, pruritic rash on her extremities two days prior to her diagnosis.

Results

Conclusion