Letter to the Editor
Pityriasis rosea Gibert type rash in an asymptomatic patient that tested positive for COVID-19
Erupción tipo pitiriasis rosada de Gibert en una paciente asintomática con positividad para COVID-19
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Multiple microbleeds can be seen that affect both the supra- and infra-tentorial compartments, located more superficially at the cortical-subcortical junction and deep, with more significant involvement, of the corpus callosum, internal capsules, and anterior white commissure. These findings suggest diffuse axonal injury.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alba Lopez-Fernández, Manuel Quintana-Diaz, Manuel Sánchez-Sánchez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Alba" "apellidos" => "Lopez-Fernández" ] 1 => array:2 [ "nombre" => "Manuel" "apellidos" => "Quintana-Diaz" ] 2 => array:2 [ "nombre" => "Manuel" "apellidos" => "Sánchez-Sánchez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775320303602" "doi" => "10.1016/j.medcli.2020.06.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320303602?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620303843?idApp=UINPBA00004N" "url" => "/23870206/0000015500000006/v2_202102250949/S2387020620303843/v2_202102250949/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2387020620303223" "issn" => "23870206" "doi" => "10.1016/j.medcle.2020.05.008" "estado" => "S300" "fechaPublicacion" => "2020-09-25" "aid" => "5224" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2020;155:272" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "One world, one health: The novel coronavirus COVID-19 epidemic" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "272" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un mundo, una salud: la epidemia por el nuevo coronavirus COVID-19" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Luis Callejas Rubio, Raquel Ríos Fernández, Norberto Ortego Centeno" "autores" => array:3 [ 0 => array:2 [ "nombre" => "José Luis" "apellidos" => "Callejas Rubio" ] 1 => array:2 [ "nombre" => "Raquel" "apellidos" => "Ríos Fernández" ] 2 => array:2 [ "nombre" => "Norberto" "apellidos" => "Ortego Centeno" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620303223?idApp=UINPBA00004N" "url" => "/23870206/0000015500000006/v2_202102250949/S2387020620303223/v2_202102250949/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Pityriasis rosea Gibert type rash in an asymptomatic patient that tested positive for COVID-19" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "273" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "David Martín Enguix, María del Carmen Salazar Nievas, Divina Tatiana Martín Romero" "autores" => array:3 [ 0 => array:4 [ "nombre" => "David" "apellidos" => "Martín Enguix" "email" => array:1 [ 0 => "davidm123m45@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "María del Carmen" "apellidos" => "Salazar Nievas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Divina Tatiana" "apellidos" => "Martín Romero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Medicina Familiar y Comunitaria, Centro de Salud Fortuny Velutti, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Clínico San Cecilio, Granada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Erupción tipo pitiriasis rosada de Gibert en una paciente asintomática con positividad para COVID-19" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1306 "Ancho" => 1740 "Tamanyo" => 164589 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The image shows a rash consisting of 0.3 to 1.5 cm in diameter round and oval erythematous scaly plaques with peripheral collarette scaling.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The emergence of the pandemic caused by the new coronavirus (COVID-19) has challenged not only the most organized health systems, but also well-established medical concepts. The high spread of the virus is partly due asymptomatic or oligosymptomatic infected subjects.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In this context, new symptoms of COVID-19 are beginning to be described, particularly outside the respiratory domain, mainly otolaryngological<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and cutaneous.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Therefore, knowledge of these manifestations becomes almost compulsory, thus increasing the number of symptoms aimed at achieving a more accurate level of suspicion, in order to increase the detection and early implementation of effective isolation measures in the population.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 19-year-old woman, non-smoker, or drinker, with a personal history of rhinitis and seasonal asthma, atopic dermatitis during childhood and an isolated episode of acute anterior uveitis. She was not undergoing any treatment on a regular basis. Presented with a 7-day history of itchy rash. On examination, an eruption consisting of round and oval erythematous squamous plaques with a peripheral scaling collarette, with distribution on the trunk and upper limbs, leaving the palms, soles, and facial area clean (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There was no evidence of a plaque or herald patch. Close contact at home with 3 relatives with compatible symptoms of mild COVID infection (fever, cough, diarrhoea, and anosmia), however, she had remained asymptomatic, except for the skin condition previously described. Although the patient's symptoms and examination suggested a Pityriasis Rosea Gibert, the epidemic environment of COVID-19 and its diversity of skin manifestations, made us think of a possible skin condition caused by the SARS-CoV-2 virus. We recommended the patient to be isolated for 14 days from the beginning of the symptoms, as established by the Spanish Ministry of Health,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> in addition to skin moisturizing measures in combination with a topical corticoid in the most pruritic lesions. Twenty days after the start of the symptoms, the presence of SARS-CoV-2 nucleic acids (PCR) was detected in a nasopharyngeal swab. Hematometry, biochemistry, venous blood gas, and coagulation parameters including ferritin, C-reactive protein, lactate dehydrogenase and D-dimer were in normal ranges. The progression of the condition was excellent, with the lesions returning within 2 weeks of the onset and almost completely disappearing after 30 days.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A recent study conducted in Italy by Recalcati S<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> revealed that 20.4% of patients hospitalized with COVID-19 developed cutaneous manifestations, some of them at the beginning of the disease and others after hospitalization. Reported manifestations are generalized erythema, hives, <span class="elsevierStyleItalic">livedo reticularis</span> and acro-ischemia (<span class="elsevierStyleItalic">chilblain</span>-<span class="elsevierStyleItalic">like</span>). We consider that this clinical case provides relevant information to doctors, since it shows a patient with exclusively cutaneous Covid-19-related symptoms of unusual appearance.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0020" class="elsevierStylePara elsevierViewall">This study has not received external funding.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martín Enguix D, Salazar Nievas MC, Martín Romero DT. Erupción tipo pitiriasis rosada de Gibert en una paciente asintomática con positividad para COVID-19. Med Clin (Barc). 2020;155:273.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1306 "Ancho" => 1740 "Tamanyo" => 164589 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The image shows a rash consisting of 0.3 to 1.5 cm in diameter round and oval erythematous scaly plaques with peripheral collarette scaling.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Linares M., Santos Larrégola L., Santo González A., Arranz Izquierdo J., Molero J.M., Jorge Bravo M.T., et al. Documento técnico. Manejo en atención primaria del COVID-19. Ministerio de Sanidad. Gob España [Accessed 17 March 2020] Available from: <a target="_blank" href="https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-China/documentos/Manejo_primaria.pdf">https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-China/documentos/Manejo_primaria.pdf</a>." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Possible link between anosmia and COVID-19: sniffing out the truth" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Marinosci" 1 => "B.N. Landis" 2 => "A. Calmy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00405-020-05966-0" "Revista" => array:5 [ "tituloSerie" => "Eur Arch Otorhinolaryngol." "fecha" => "2020" "paginaInicial" => "1" "paginaFinal" => "2" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25308243" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous manifestations in COVID-19: a first perspective" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. Recalcati" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/jdv.16387" "Revista" => array:2 [ "tituloSerie" => "J Eur Acad Dermatol Venereol." "fecha" => "2020" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015500000006/v2_202102250949/S2387020620303776/v2_202102250949/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015500000006/v2_202102250949/S2387020620303776/v2_202102250949/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020620303776?idApp=UINPBA00004N" ]
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