SciELO - Brazil - A case of COVID-19 with papulovesicular rash that progressed to retiform purpura, accompanied by cherry angiomas A case of COVID-19 with papulovesicular rash that progressed to retiform purpura, accompanied by cherry angiomas
Cherry angiomas are generally seen on the trunk in middle-aged adults. Their pathogenesis is not well understood. It has been suggested that immune dysregulation of the skin could be a predisposing factor for the development of eruptive cherry angiomas.9 Cherry angiomas in COVID-19 cases have only been rarely reported in the literature. Eruptive cherry angioma of the back has been reported.7 Cherry angiomas were noticed in the case of our patient when the lesions gained reticular purpuric characteristics. The simultaneous occurrence of two types of lesions may indicate a common etiopathogenesis. In a previous study, it was determined histopathologically that angiotensin-converting enzyme 2 (ACE2) receptors were secreted from endothelial cells and that the virus caused endotheliitis through this receptor.10 Retiform purpura and eruptive cherry angioma formation in the patient could be caused by endotheliitis. The occurrences of lesions on the patient’s extremities made it easier to recognize and monitor them.
Endothelial cell involvement in COVID-19 patients was recently observed. It was demonstrated histologically that these cells express ACE2 receptors, through which SARS-CoV-2 manages to infect the host, accompanied by viral elements and inﬂammatory cells. These ﬁndings suggest that SARS-CoV-2 infection may produce endotheliitis in different organs, including the skin, as a direct effect from the presence of the virus and host’s inﬂammatory response.10 Maculopapular rash, one of the skin manifestations associated with coronavirus, is the most frequently reported skin manifestation, although cases of retiform purpura and, rarely, cherry angioma have also been reported