COVID-19 can present with a rash and be mistaken for dengue
Authors: Beuy Joob, Viroj Wiwanitkit
Journal: Journal of the American Academy of Dermatology (2020)

To the Editor: We found the report "What are we doing in the dermatology outpatient department amidst the raging of 2019-CoV?" to be very interesting.1Chen Y. Pradhan S. Xue S. What are we doing in the dermatology outpatient department amidst the raging of the 2019 novel coronavirus.J Am Acad Dermatol. 2020; 82: 1034Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar Chen et al pointed out the need for a dermatology department to recognize and deal with this infection. We would like to share our experience from Thailand, the second country in which the COVID-19 infection occurred since early January 2020.2Yasri S. Wiwanitkit V. Editorial: Wuhan coronavirus outbreak and imported case.Adv Trop Med Pub Health Int. 2019; 9: 1-2Google Scholar At present (March 5, 2020), there are 48 accumulated COVID-19 cases in Thailand. Among these 48 cases, there was an interesting case in which the patient presented with a skin rash with petechiae. Because dengue is very common in our setting, petechiae rash is a common clinical finding in dengue, and the patient also had low platelet count, a clinical diagnosis of dengue was made by the first physician in charge. There was no photograph and a biopsy was not done because biopsy is not a routine practice according to dengue clinical practice guidelines in our tropical setting. The patient was initially misdiagnosed as dengue, which resulted in a delayed diagnosis.3Joob B. Wiwanitkit V. COVID-19 in medical personnel: observation from Thailand.J Hosp Infect. 2020; ([Epub ahead of print])https://doi.org/10.1016/j.jhin.2020.02.016Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar In this case, the patient further presented respiratory problems and was referred to the tertiary medical center. Other common virus infections that might cause fever, rash, and respiratory problem were ruled out by laboratory investigation, and the final diagnosis of COVID-19 infection was confirmed by RT-PCR. There is a possibility that a patient with COVID-19 might initially present with a skin rash that can be misdiagnosed as another common disease. In addition, some of these patients are afebrile initially.4Huang C. Wang Y. Li X. et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020; 395: 497-506Abstract Full Text Full Text PDF PubMed Scopus (33099) Google Scholar The practitioner should recognize the possibility that the patient might have only a skin rash and think of this disease to prevent transmission. What are we doing in the dermatology outpatient department amidst the raging of the 2019 novel coronavirus?Journal of the American Academy of DermatologyVol. 82Issue 4PreviewIn late December 2019, several individuals with unexplained pneumonia were reported in Wuhan, China. A novel coronavirus was subsequently identified as the causative pathogen and provisionally designated 2019 novel coronavirus (2019-nCoV).1 As of February 10, 2020, 42,638 cases of 2019-nCoV infection have been confirmed in China, with 21,675 suspected cases and 1016 deaths. There are still more than 3000 confirmed cases every day, involving people living in or visiting Wuhan, as a subsequent characteristic of human-to-human transmission. Full-Text PDF Reply to "COVID-19 can present with a rash and be mistaken for dengue": Petechial rash in a patient with COVID-19 infectionJournal of the American Academy of DermatologyVol. 83Issue 2PreviewTo the Editor: We read with interest the article by Joob et al1 hypothesizing that COVID-19 infection might present with a skin rash and petechiae. During the COVID-19 outbreak in China, clinical studies did obviously not focus on the skin manifestations of COVID-19. However, it is likely they exist and are probably under-recognized because of the current lack of dermatology consultations in these patients. Recently, Recalcati et al2 reported the cutaneous manifestations of COVID-19 infection in Italy and described 3 main patterns: erythematous rash, urticaria, and chickenpox-like lesions. Full-Text PDF A dermatologic manifestation of COVID-19: Transient livedo reticularisJournal of the American Academy of DermatologyVol. 83Issue 2Preview Full-Text PDF