Methods
We evaluated the personal history and photographs of skin lesions of 26 patients, sent to us by their pediatrician, through multidisciplinary telematic meetings with dermatologists, rheumatological pediatricians, infectious disease specialist. We only included patients with pernio-like skin lesions (nine patients). We have excluded patients who were unable to perform the swab before hospital admission, patients whose parents did not obtain consent and patients with autoimmune diseases. We collected informed consent to obtain clinical information and photos of patients to be included in the study and to perform blood chemistry sampling. Therefore, we evaluated 9 cases of children who were referred to the Section of Pediatric Rheumatology, of General Pediatric Unit, department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, since March to April 2020 during outbreak of COVID-19. We have created a medical record in which we have included demographic information on patients, family and personal medical history, clinical manifestations and follow-up. We analyzed the photos of these patients at the time of the onset of symptoms and we assessed the cutaneous manifestations when they were admitted in the outpatient setting of the hospital. They underwent blood chemistry: a complete blood count (CBC), renal, hepatic, muscle function tests, urine test, complement levels, immunoglobulins, coagulation studies (prothrombin time, activated partial thromboplastin time, thrombin time and D-dimer test), rheumatoid factor (FR), antinuclear antibodies (ANA), extractable nuclear antigens (ENA), double stranded DNA (nDNA), anti-topoisomerase I (anti- SCL70), antiphospholipid antibodies (aPL), anti-cardiolipin (aCL), anti- β-2-glycoprotein 1(β2GP1), and Lupus anticoagulant (LAC). In addiction, serology was performed using a chemiluminescent microparticle immunoassay (CLIA) for detection of IgG antibodies directed against the nucleocapsid protein of SARS-CoV2 and IgM.