Coronavirus infection-induced chilblains11Kolivras A, Dehavay F,
Delplace D, et al. Coronavirus (COVID-19) infection-induced
chilblains: A case report with histopathologic findings [published
online ahead of print, 2020 Apr 18]. JAAD Case Rep.
2020;6(6):489‐492.:
A mechanism has recently been considered to explain the appearance of
autoimmune phenomena following the whole SARS-CoV2 infection: molecular
mimicry22Cappello F Is. COVID-19 a proteiform disease inducing
also molecular mimicry phenomena? Cell Stress Chaperones 2020
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Z, Karimi N. Guillain Barre syndrome associated with COVID-19
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S0967-5868(20)30882-1.,44Cappello F.
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S0967-5868(20) 31156-5. Lucchesi and Floel55Lucchese G, Flöel
A. Molecular mimicry between SARS-CoV-2 and respiratory pacemaker
neurons. Autoimmun Rev 2020 May 1:102556https://doi.org/10.1016/j.
autrev.2020.102556 have hypothesized a molecular mimicry mechanism
between neuronal proteins present in the brain stem respiratory
pacemaker neurons (DAB1, AIFM and SURF1) and viral epitopes of SARS-CoV2
treated antigenic. The same mechanism according to Angileri et al. could
be responsible for anosmia, leukopenia and multi-organ failure caused by
vascular damage, assuming they are associated with the molecular mimicry
66Angileri F. Molecular mimicry may explain multi-organ damage
in COVID-19 Autoimmunity Reviews 2020 May 18
https://doi.org/10.1016/j.autrev.2020.102591.. A type 3
hypersensitivity therefore occurs with the deposition of antibody
antigen complexes precipitate inside the tissues, in particular the
blood vessels, inducing a serious inflammatory state by the action of
the complement anaphylatoxins (C3a and C5a), which in turn stimulate the
release of histamine from mast cells and the recruitment of phagocytes,
first in neutrophils, the main cause of tissue damage and following
«leukocytoclastic vasculitis» (LCV), also reported in the English
medical literature from the term «hypersensitivity vasculitis77C.A.
Janeway Jr., P. Travers, M. Walport, M. Shlomchik, Immunobiology: the
immune system in health and disease, fifth ed., Garland Science, New
York, 2001,88D. Baigrie, P. Bansal, A.
Goyal, J.S. Crane, Leukocytoclastic vasculitis (hypersensitivity
vasculitis), StatPearls Publishing, Treasure Island, 2020». This
pathogenic mechanisms could explain the appearance of chilblain-like
lesions due to SARS COV-2 infection. In conclusion we think there is a
correlation between chilblain like lesion and SARS-Cov2 infection, but
further studies are needed to prove it. We hypothesize this for an
increased number of this skin lesions described in the literature during
this period, as in our experience, and also because such lesions
appeared at a time when temperatures were mild in Southern Italy and
patients were at home because of the lockdown. To our knowledge, this is
one of the few studies that collects a series of patients with chilblain
like lesions, evaluating the possible association with COVID 19
(oropharyngeal swab and serology test) but also for rheumatological
diseases. Many questions remain open about interaction host-virus.
ACKNOWLEDGMENTS : Thanks to Italian Federation of Pediatrician (FIMP) of
Messina for collaboration.
IMPACT STATEMENT
During the outbreak of COVID-19 many chilblain-like lesions are being
increasingly reported.The increase in the number of cases of
chilblain-like lesions compared to the cases with which we come into
contact in our clinical practice every year, in association with the
mild temperatures observed in those months in Southern Italy and the
concomitant lockdown, led us to hypothesize a possible correlation with
SARS Cov 2 infection. To our knowledge, this is one of the few studies
that collects a series of patients with chilblain like lesions,
evaluating the possible association with COVID 19 (oropharyngeal swab
and serology test) but also for rheumatological diseases.
REFERENCES