Pitiriasis rosada como manifestación dermatológica de infección por SARS-CoV-2: a propósito de un caso

Palabras clave: pitiriasis rosada, COVID-19, SARS-CoV-2, coronavirus, piel, urticaria, exantema, manifestaciones cutáneas.

Resumen

Las manifestaciones cutáneas relacionadas a la infección por el coronavirus SARS-CoV-2, causante de COVID-19, se han descrito entre el 0,2% y 20,4% de las personas que cursan con esta enfermedad. Las más frecuentemente descritas son: lesiones maculopapulares (47%), lesiones acrales eritematosas con vesículas o pústulas (pseudoperniosis) (19%), urticariales (19%), lesiones vesiculosas (9%) y livedo/necrosis (6%). En particular, la pitiriasis rosada es una dermatosis autolimitada de etiología desconocida, sin embargo, se ha visto asociada a la infección por SARS-CoV-2, con algunos reportes de casos en la literatura. El mecanismo fisiopatológico de las lesiones cutáneas en COVID-19 no es claro, y se han planteado algunas teorías, entre las cuales está el papel que juega la enzima convertidora de angiotensina 2 (ACE2) utilizada por el virus para infectar las células, los infiltrados linfocíticos, los depósitos de factores del complemento en la piel, y la reactivación de virus latentes como los herpes virus humanos. Se presenta el caso de una paciente con pitiriasis rosada asociada a COVID-19 y se describen los casos reportados hasta la fecha.

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Biografía del autor/a

Jhon Edwar García-Rueda, Universidad de Antioquia

Médico General, Hospital Pablo Tobón Uribe. Docente de Cátedra, Universidad de Antioquia. Medellín, Colombia. https://orcid.org/0000-0002-9394-7361

Ana María Caicedo-Bolaños, Hospital Pablo Tobón Uribe

Médica General, Residente de Ginecología y Obstetricia, Universidad de Antioquia. Hospital Pablo Tobón Uribe, Medellín, Colombia. https://orcid.org/0000-0001-9927-4009 

Angélica María Bermúdez-Flórez, Universidad de Antioquia

Médica General, Universidad de Antioquia. Medellín, Colombia. https://orcid.org/0000-0003-4891-6352

Felipe Baena-Gallego, Universidad CES

Médico General, Residente de Medicina de Urgencias, Universidad CES. Medellín, Colombia.
https://orcid.org/0000-0003-3812-6154

Luz Adriana Gómez-Ramírez, Hospital Pablo Tobón Uribe

Médica General, Hospital Pablo Tobón Uribe. Medellín, Colombia. https://orcid.org/0000-0003-1564-1751

Ana Lucía Correa-Ángel, Hospital Pablo Tobón Uribe

Médica, Especialista en Medicina Interna, Especialista en Infectología. Departamento de Prevención y Control de Infecciones, Hospital Pablo Tobón Uribe. Medellín, Colombia. https://orcid.org/0000-0001-9088-2251

Luz Adriana Vásquez-Ochoa, Hospital Pablo Tobón Uribe

Médica, Especialista en Dermatología. Departamento de Dermatología, Hospital Pablo Tobón Uribe. Medellín, Colombia. https://orcid.org/0000-0002-3503-2710

Referencias bibliográficas

Litchman G, Nair PA, Le JK J. Pityriasis rosea. Treasure Island (FL): StatPearls Publishing; 2022. Acceso 30 de enero de 2022. Disponible en https://www.ncbi.nlm.nih.gov/books/NBK448091/.

Birlutiu V, Birlutiu RM, Iancu GM. Pityriasis rosea Gibert triggered by SARS-CoV-2 infection: A case report. Medicine (Baltimore) 2021;100:e25352. https://doi.org/10.1097/md.0000000000025352.

Elsaie M, Youssef E, Hesham N. Pityriasis rosea-like rash as a cutaneous marker for COVID-19 infection. J Drugs Dermatol 2020;19:779-780. https://doi.org/10.36849/JDD.2020.5360.

Bostan E, Jarbou A. Atypical pityriasis rosea associated with mRNA COVID-19 vaccine. J Med Virol 2021. [Epub ahead of print] 29 de septiembre de 2021. https://doi.org/10.1002/jmv.27364.

Urbina F, Das A, Sudy E. Clinical variants of pityriasis rosea. World J Clin Cases 2017;5:203-211. https://doi.org/10.12998/wjcc.v5.i6.203.

Paolino G, Di Nicola MR, Cantisani C, Mercuri SR. Pityriasis rosea infection in a COVID-19 patient successfully treated with systemic steroid and antihistamine via telemedicine: Literature update of a possible prodromal symptom of an underlying SARS-CoV-2 infection. Dermatol Ther 2021;34:e14972. https://doi.org/10.1111/dth.14972.

Ciccarese G, Parodi A, Drago F. SARS-CoV-2 as possible inducer of viral reactivations. Dermatol Ther 2020;33:e13878. https://doi.org/10.1111/dth.13878.

Dursun R, Temiz SA. The clinics of HHV-6 infection in COVID-19 pandemic: Pityriasis rosea and Kawasaki disease. Dermatol Ther 2020;33:e13730. https://doi.org/10.1111/dth.13730.

Neoh CY, Tan AW, Mohamed K, Sun YJ, Tan SH. Characterization of the inflammatory cell infiltrate in herald patches and fully developed eruptions of pityriasis rosea. Clin Exp Dermatol 2010;35:300-304. https://doi.org/10.1111/j.1365-2230.2009.03469.x.

World Health Organization (WHO). Weekly epidemiological update on COVID-19-25 January 2022. Ginebra, Suiza: World Health Organization; 2022. P. 28. Acceso 30 de enero de 2022. Disponible en https://www.who.int/publications/m/item/weekly-epidemiological-update-on-covid-19---25-january-2022.

Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents 2020;55:105955. https://doi.org/10.1016/j.ijantimicag.2020.105955.

Sousa-Gonçalves C, Reis-Carreira N, Passos D, Barbosa AL, Baltazar AM, Wahnon A, et al. Erythematous papular rash: A dermatological feature of COVID-19. Eur J Case Rep Intern Med 2020;7:001768. https://doi.org/10.12890/2020_001768.

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-1720. https://doi.org/10.1056/NEJMoa2002032.

Wang CJ, Worswick S. Cutaneous manifestations of COVID-19. Dermatol Online J 2021;27:13030/qt2m54r7nv. https://doi.org/10.5070/D3271052017.

Zhao Q, Fang X, Pang Z, Zhang B, Liu H, Zhang F. COVID-19 and cutaneous manifestations: a systematic review. J Eur Acad Dermatol Venereol 2020;34:2505-2510. https://doi.org/10.1111/jdv.16778.

Andina D, Belloni-Fortina A, Bodemer C, Bonifazi E, Chiriac A, Colmenero I, et al. Skin manifestations of COVID-19 in children: Part 3. Clin Exp Dermatol 2021;46:462-472. https://doi.org/10.1111/ced.14483.

Arredondo MI, Gómez LV, Del Río-Cobaleda DY. Manifestaciones dermatológicas de COVID-19: ¿casualidad o causalidad? CES Medicina 2020;34:34-41. https://doi.org/10.21615/cesmedicina.34.COVID-19.7.

Sameni F, Hajikhani B, Yaslianifard S, Goudarzi M, Owlia P, Nasiri MJ, et al. COVID-19 and skin manifestations: An overview of case reports/case series and meta-analysis of prevalence studies. Front Med (Lausanne) 2020;7:573188. https://doi.org/10.3389/fmed.2020.573188.

Tammaro A, Adebanjo GAR, Parisella FR, Pezzuto A, Rello J. Cutaneous manifestations in COVID-19: the experiences of Barcelona and Rome. J Eur Acad Dermatol Venereol 2020;34:e306-e307. https://doi.org/10.1111/jdv.16530.

Carrascosa JM, Morillas V, Bielsa I, Munera-Campos M. Cutaneous manifestations in the context of SARS-CoV-2 infection (COVID-19). Actas Dermosifiliogr 2020;111:734-742. https://doi.org/10.1016/j.ad.2020.08.002.

Freeman EE, McMahon DE, Lipoff JB, Rosenbach M, Kovarik C, Desai SR, et al. The spectrum of COVID-19-associated dermatologic manifestations: An international registry of 716 patients from 31 countries. J Am Acad Dermatol 2020;83:1118-1129. https://doi.org/10.1016/j.jaad.2020.06.1016.

Galván-Casas C, Català A, Carretero-Hernández G, Rodríguez-Jiménez P, Fernández-Nieto D, Rodríguez-Villa Lario A, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol 2020;183:71-77. https://doi.org/10.1111/bjd.19163.

Veraldi S, Spigariolo CB. Pityriasis rosea and COVID-19. J Med Virol 2021;93:4068. https://doi.org/10.1002/jmv.26679.

Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol 2020;34:e212-213. https://doi.org/10.1111/jdv.16387.

Mohta A, Mohta A, Nai RS, Arora A, Jain SK, Mohta A, et al. An observational study of mucocutaneous manifestations among SARS-CoV-2 patients from three COVID-19 dedicated tertiary care centers. Indian Dermatol Online J 2021;12:687-695. https://doi.org/10.4103/idoj.IDOJ_127_21.

Welsh E, Cardenas-de la Garza JA, Cuellar-Barboza A, Franco-Marquez R, Arvizu-Rivera RI. SARS-CoV-2 spike protein positivity in pityriasis rosea-like and urticaria-like rashes of COVID-19. Br J Dermatol 2021;184:1194-1195. https://doi.org/10.1111/bjd.19833.

Andina D, Belloni-Fortina A, Bodemer C, Bonifazi E, Chiriac A, Colmenero I, et al. Skin manifestations of COVID-19 in children: Part 1. Clin Exp Dermatol 2021;46:444-450. https://doi.org/10.1111/ced.14481.

Andina D, Belloni-Fortina A, Bodemer C, Bonifazi E, Chiriac A, Colmenero I, et al. Skin manifestations of COVID-19 in children: Part 2. Clin Exp Dermatol 2021;46:451-461. https://doi.org/10.1111/ced.14482.

Drago F, Ciccarese G, Rebora A, Parodi A. Human herpesvirus-6, -7, and Epstein-Barr virus reactivation in pityriasis rosea during COVID-19. J Med Virol 2021;93:1850-1851. https://doi.org/10.1002/jmv.26549.

Broccolo F, Drago F, Careddu AM, Foglieni C, Turbino L, Cocuzza CE, et al. Additional evidence that pityriasis rosea is associated with reactivation of human herpesvirus-6 and -7. J Invest Dermatol 2005;124:1234-1240. https://doi.org/10.1111/j.0022-202X.2005.23719.x.

Müller JA, Groß R, Conzelmann C, Krüger J, Merle U, Steinhart J, et al. SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas. Nat Metab 2021;3:149-165. https://doi.org/10.1038/s42255-021-00347-1.

Ndeupen S, Bouteau A, Herbst C, Qin Z, Hutchins Z, Kurup D, et al. Langerhans cells and cDC1s play redundant roles in mRNA-LNP induced protective anti-influenza and anti-SARS-CoV-2 responses. bioRxiv 2021. https://doi.org/10.1101/2021.08.01.454662.

Veraldi S, Romagnuolo M, Benzecry V. Pityriasis rosea-like eruption revealing COVID-19. Australas J Dermatol 2021;62:e333-334. https://doi.org/10.1111/ajd.13504.

Ehsani AH, Nasimi M, Bigdelo Z. Pityriasis rosea as a cutaneous manifestation of COVID-19 infection. J Eur Acad Dermatol Venereol 2020;34:e436-437. https://doi.org/10.1111/jdv.16579.

Martín-Enguix D, Salazar-Nievas MDC, Martín-Romero DT. Pityriasis rosea Gibert type rash in an asymptomatic patient that tested positive for COVID-19. Med Clin (Engl Ed) 2020;155:273. https://doi.org/10.1016/j.medcle.2020.05.017.

Sanchez A, Sohier P, Benghanem S, L'Honneur AS, Rozenberg F, Dupin N, et al. Digitate papulosquamous eruption associated with severe acute respiratory syndrome coronavirus 2 infection. JAMA Dermatol 2020;156:819-820. https://doi.org/10.1001/jamadermatol.2020.1704.

Merhy R, Sarkis AS, Stephan F. Pityriasis rosea as a leading manifestation of COVID-19 infection. J Eur Acad Dermatol Venereol 2021;35:e246-247. https://doi.org/10.1111/jdv.17052.

Johansen M, Chisolm SS, Aspey LD, Brahmbhatt M. Pityriasis rosea in otherwise asymptomatic confirmed COVID-19-positive patients: A report of 2 cases. JAAD Case Rep 2021;7:93-94. https://doi.org/10.1016/j.jdcr.2020.10.035.

Ng SM. Prolonged dermatological manifestation 4 weeks following recovery of COVID-19 in a child. BMJ Case Rep 2020;13:e237056. https://doi.org/10.1136/bcr-2020-237056.

Duong TA, Velter C, Rybojad M, Comte C, Bagot M, Sulimovic L, et al. Did Whatsapp(®) reveal a new cutaneous COVID-19 manifestation? J Eur Acad Dermatol Venereol 2020;34:e348-350. https://doi.org/10.1111/jdv.16534.

Gambichler T, Boms S, Susok L, Dickel H, Finis C, Abu-Rached N, et al. Cutaneous findings following COVID-19 vaccination: review of world literature and own experience. J Eur Acad Dermatol Venereol 2022;36:172-180. https://doi.org/10.1111/jdv.17744.

Pedrazini MC, da Silva MH. Pityriasis rosea-like cutaneous eruption as a possible dermatological manifestation after Oxford-AstraZeneca vaccine: Case report and brief literature review. Dermatol Ther 2021;34:e15129. https://doi.org/10.1111/dth.15129.

McMahon DE, Amerson E, Rosenbach M, Lipoff JB, Moustafa D, Tyagi A, et al. Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases. J Am Acad Dermatol 2021;85:46-55. https://doi.org/10.1016/j.jaad.2021.03.092.

Català A, Muñoz-Santos C, Galván-Casas C, Roncero-Riesco M, Revilla-Nebreda D, Solá-Truyols A, et al. Cutaneous reactions after SARS-CoV-2 vaccination: a cross-sectional Spanish nationwide study of 405 cases. Br J Dermatol 2022;186:142-152. https://doi.org/10.1111/bjd.20639.

McMahon DE, Kovarik CL, Damsky W, Rosenbach M, Lipoff JB, Tyagi A, et al. Clinical and pathologic correlation of cutaneous COVID-19 vaccine reactions including V-REPP: A registry-based study. J Am Acad Dermatol 2022;86:113-121. https://doi.org/10.1016/j.jaad.2021.09.002.

Temiz SA, Abdelmaksoud A, Dursun R, Durmaz K, Sadoughifar R, Hasan A. Pityriasis rosea following SARS-CoV-2 vaccination: A case series. J Cosmet Dermatol 2021;20:3080-3084. https://doi.org/10.1111/jocd.14372.

Leerunyakul K, Pakornphadungsit K, Suchonwanit P. Case report: pityriasis rosea-like eruption following COVID-19 vaccination. Front Med (Lausanne) 2021;8:752443. https://doi.org/10.3389/fmed.2021.752443.

Cómo citar
1.
García-Rueda JE, Caicedo-Bolaños AM, Bermúdez-Flórez AM, Baena-Gallego F, Gómez-Ramírez LA, Correa-Ángel AL, Vásquez-Ochoa LA. Pitiriasis rosada como manifestación dermatológica de infección por SARS-CoV-2: a propósito de un caso. Med. Lab. [Internet]. 4 de abril de 2022 [citado 23 de mayo de 2022];26(2):177-86. Disponible en: https://medicinaylaboratorio.com/index.php/myl/article/view/575
Publicado
2022-04-04
Sección
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