About: Abstract Paraviral eruptions, such as the papular-purpuric gloves and socks syndrome or eruptive pseudoangiomatosis,share the following features that distinguish them from a classic viral eruption: they are highly recognizable; the eruption usually lasts a few weeks; many different viruses and sometimes other agents can trigger them; on microscopic examination, there is no specific cytopathogenic viral effect. SARS-CoV-2 can induce both a classic viral eruption and a paraviral eruption, the meaning of which in terms of pathophysiology and prognosis are very different. Some patients infected with COVID-19 have a papulovesicular eruption involving mainly the trunk. Those patients have active viremia, and some have developed pneumonia and died. Biopsy of the eruption revealed cytopathogenic viral effect, and thus a direct interaction of the virus with the skin; it is, therefore, a classic viral exanthema. Other, mainly young patients, developed chilblains of the fingers and toes 3 or 4weeks after minor signs of COVID-19 or after contact with a diseased person. They did not develop severe COVID-19. Biopsy revealed classic findings of chilblains without cytopathogenic viral effect. Most of those patients did not develop specific antibodies. Those chilblains can be considered as paraviral. Classic viral manifestations are the consequence of a direct interaction of the skin with the virus, while paraviral manifestations result from the activation of the immune system. In the case of paraviral chilblains, I hypothesize that it is the innate immune system that rejects SARS-CoV-2. Chilblains are also observed in rare monogenic disorders called type 1 interferonopathies, where anti-viral innate immunity is abnormally activated. This would explain why these individuals do not develop specific antibodies, because they are probably naturally resistant to SARS-CoV-2 infection via their innate immune system.   Goto Sponge  NotDistinct  Permalink

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  • Abstract Paraviral eruptions, such as the papular-purpuric gloves and socks syndrome or eruptive pseudoangiomatosis,share the following features that distinguish them from a classic viral eruption: they are highly recognizable; the eruption usually lasts a few weeks; many different viruses and sometimes other agents can trigger them; on microscopic examination, there is no specific cytopathogenic viral effect. SARS-CoV-2 can induce both a classic viral eruption and a paraviral eruption, the meaning of which in terms of pathophysiology and prognosis are very different. Some patients infected with COVID-19 have a papulovesicular eruption involving mainly the trunk. Those patients have active viremia, and some have developed pneumonia and died. Biopsy of the eruption revealed cytopathogenic viral effect, and thus a direct interaction of the virus with the skin; it is, therefore, a classic viral exanthema. Other, mainly young patients, developed chilblains of the fingers and toes 3 or 4weeks after minor signs of COVID-19 or after contact with a diseased person. They did not develop severe COVID-19. Biopsy revealed classic findings of chilblains without cytopathogenic viral effect. Most of those patients did not develop specific antibodies. Those chilblains can be considered as paraviral. Classic viral manifestations are the consequence of a direct interaction of the skin with the virus, while paraviral manifestations result from the activation of the immune system. In the case of paraviral chilblains, I hypothesize that it is the innate immune system that rejects SARS-CoV-2. Chilblains are also observed in rare monogenic disorders called type 1 interferonopathies, where anti-viral innate immunity is abnormally activated. This would explain why these individuals do not develop specific antibodies, because they are probably naturally resistant to SARS-CoV-2 infection via their innate immune system.
subject
  • Virology
  • Zoonoses
  • Autoimmune diseases
  • COVID-19
  • Dermatologic terminology
  • Skin conditions resulting from physical factors
  • Effects of external causes
  • Foot diseases
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