Acute urticaria in patients with COVID-19

Information about the epidemiology, clinical features, prevention and treatment of a new coronavirus infection caused by the SARS-CoV-2 virus is continuously updated and updated. The most common clinical manifestations of COVID-19 are hyperthermia, symptoms of intoxication, cough, shortness of breath, decreased sense of smell and taste, less often abdominal pain, vomiting, diarrhea and other extrapulmonary manifestations. The main target of SARS-CoV-2 is type II alveolar cells, which defines lung damage as the main clinical manifestation of COVID-19. Damage to the neurons of the brain and glia leads to neurological symptoms (fever with headaches, loss of sense of smell, taste, ataxia and seizures). Immunological complications leading to cytokine storm syndrome and acute respiratory distress syndrome play a special role in the pathogenesis of COVID-19 coronavirus infection.

Recently, clinical observations have been increasingly appearing describing dermatological skin lesions as a variant of the manifestation of COVID-19 coronavirus infection, including at the onset of the disease, i.e. before the appearance of any signs of the disease. The specificity of skin symptoms in COVID-19 has not yet been proven, and some authors use the term “unexplained skin manifestations of COVID-19”.

The article presents a description of clinical cases of acute idiopathic urticaria at the onset of COVID-19, that does not respond to treatment with antihistamines. On the skin of the chest, abdomen, back, buttocks, arms and legs of patients, multiple, edematous, merging, bright pink, various sizes of urticaria were observed, appearing simultaneously with weakness, partial loss of taste, smell, muscle pain, temperature rise to 38–39ºС. Taking a single dose of the glucocorticoid combined drug betamethasone improved the patient’s condition within a day; in a man on the 7th day and in a woman on the 3rd day of antiviral therapy with favipiravir, all rashes disappeared. In the general blood test after 2 weeks of treatment, a slight negative dynamics was noted: in a man ― absolute leukopenia (3.6×10⁹/l), relative lymphocytosis (51%), an increase in ESR up to 28 mm/h, in a woman ― absolute leukopenia (3.4×10⁹/l), relative lymphocytosis (57%). The patients were discharged after a month of treatment with antiviral drugs in satisfactory condition with two negative PCR results for COVID-19.

The data obtained suggest that acute urticaria that cannot be treated with antihistamines in COVID-19 can be considered one of the variants of the course of a new coronavirus infection (SARS-CoV-2), and require further in-depth study.