Polymorphism of exanthema, caused by SARS­Cov­2 virus (clinical case)

Abstract

Objective — to improve the clinical diagnosis and management of the new coronavirus disease by describing a clinical case of viral exanthema as a result of infection with a new strain of SARS-CoV-2. Materials and methods. A description is presented of the clinical symptoms and features of skin lesions in the new coronavirus disease in a patient with probable Grover’s disease diagnosed during a pathological examination of a biopsy specimen of the affected skin. Results and discussion. The clinical diversity of the strain of the new SARS-CoV-2 coronavirus is due to the fact that coronavirus infection is a systemic viral infection that can affect any organ and system. The pathogenesis of these lesions is due to two mechanisms: direct virus damage to the body’s cells and the emergence of an immunopathological process that resembles systemic vasculitis. The ambivalence of immunopathogenesis is reflected in this clinical case.Several factors of the occurrence of dermatological lesions in a patient with a polymorphic rash with SARS-CoV-2 infection have been identified: chemical (sensitization due to working with chemical compounds), physical (mechanical pressure during the performance of professional duties), immunopathological (tendency to hyperergic reactions of the dermis) and thermal, which could provoke the appearance of signs of Grover’s disease. At the same time, the systemic viral infection with SARS-CoV-2 was a trigger for the immunopathological processes, manifested by skin lesions. Conclusions. Currently, there are no significant predictors of the course of coronavirus disease and the occurrence of complications. Therefore, a patient who has had a coronavirus infection should be advised a follow up (communication with a doctor) for 12 weeks. A patient with any dermatological pathology should be examined for specific markers of COVID-19. In the differential diagnosis discourse of the dermatological disease, COVID-19 should always be considered as a possible cause until proven otherwise. During therapy, vitamins, immunomodulators, antibiotics that do not have an evidence base should not be routinely prescribed to all patients, especially those who are at risk of developing immunopathological reactions due to occupational or toxicological anamnesis.