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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Histopathology and immunophenotyping of late onset cutaneous manifestations of COVID-19 in elderly patients: Three case reports
Maria Mazzitelli, Stefano Dastoli, Chiara Mignogna, Luigi Bennardo, Elena Lio, Maria Chiara Pelle, Enrico Maria Trecarichi, Branca Isabel Pereira, Steven Paul Nisticò, Carlo Torti
Maria Mazzitelli, Elena Lio, Enrico Maria Trecarichi, Carlo Torti, Department of Medical and Surgical Sciences, Infectious and Tropical Disease Unit, Magna Graecia University, Catanzaro 88100, Italy
Stefano Dastoli, Steven Paul Nisticò, Department of Health Sciences, Magna Graecia Università of Catanzaro, Catanzaro 88100, Italy
Chiara Mignogna, Interdipartimental Service Center, Pathology Unit, Pugliese Ciaccio Hospital, Catanzaro 88100, Italy
Luigi Bennardo, Department of Health Sciences, Magna Graecia University, Catanzaro 88100, Italy
Maria Chiara Pelle, Department of Medical and Surgical Sciences, Magna Graecia Università of Catanzaro, Catanzaro 88100, Italy
Branca Isabel Pereira, HIV/GUM Directorate, Chelsea and Westminster Hospital Foundation Trust, London SW109NH, United Kingdom
Author contributions: Mazzitelli M and Dastoli S contributed to this work equally; Mazzitelli M and Dastoli S reviewed the literature and contributed to manuscript drafting; Bennardo L and Lio E reviewed the literature and contributed to manuscript drafting; Mignogna C performed the immunohistological analyses and interpretation and contributed to manuscript drafting; Mazzitelli M, Dastoli S and Nisticò SP analyzed and interpreted the imaging findings; Trecarichi EM and Torti C performed the infectious diseases consultation, reviewed the literature and drafted the manuscript; Trecarichi EM, Pereira BI, Nisticò SP and Torti C were responsible for the revision of the manuscript for important intellectual content; Pereira BI reviewed English language; all authors issued final approval for the version to be submitted.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None declared for all the authors. Dr. Mazzitelli M was supported as PhD student by European Commission (FESR FSE 2014-2020) and by Calabria Region (Italy). European Commission and Calabria Region cannot be held responsible for any use which may be made of information contained therein.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Maria Mazzitelli, MD, Academic Fellow, Department of Medical and Surgical Sciences, Infectious and Tropical Disease Unit, Magna Graecia University, Viale Europa, Catanzaro 88100, Italy. m.mazzitelli88@gmail.com
Received: March 21, 2021
Peer-review started: March 21, 2021
First decision: April 29, 2021
Revised: May 12, 2021
Accepted: May 27, 2021
Article in press: May 27, 2021
Published online: July 16, 2021
BACKGROUND
Several cutaneous manifestations such as urticarial rash, erythematous patches and chilblain-like lesions have been described in young adults with coronavirus disease 2019 (COVID-19) and are present in up to 20% patients, but few reports exist describing histopathological and immunophenotypic characteristics of dermatological lesions in older patients. Our aim was to characterize skin lesions in elderly patients during late stages of COVID-19 from clinical, histological and immunophenotypic perspectives.
CASE SUMMARY
Three patients, admitted for COVID-19, and who developed cutaneous manifestations underwent skin biopsies. Immunophenotypic analysis for CD20, CD3, CD4 and CD8 was performed on skin biopsies to assess immune cell infiltrates. CD1a was used as a marker of Langerhans cells, and CD31 as a marker of endothelial cells. In the three study patients, cutaneous manifestations were evident in the late-stage of COVID-19 (mean time from the first positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swab to rash onset was 35 d). Skin biopsies showed a similar pattern of T lymphocyte infiltration in all patients. Indeed, a chronic dermatitis with perivascular lymphocytic infiltrate was observed with predominance of CD3+ T-cell (CD3+).
CONCLUSION
Our study confirms previous reports. Histological and immunophenotypic patterns in our patients confirm results described in the two previous reported experiences. This pattern is similar to what is found in some lympho-proliferative disorders. Therefore, since these findings are non-specific, SARS-CoV-2 infection should be suspected.
Core Tip: We report results of histological and immunophenotypic analysis of skin rashes in three elderly patients with coronavirus disease 2019 (COVID-19). We found a pattern of T lymphocyte infiltration similar to that present in some lympho-proliferative disorders. In order to clarify the pathogenesis and the clinical significance if skin lesions in patients with COVID-19, further studies on histology and immunophenotyping are necessary.
