Methods
We evaluated the personal history and photographs of skin lesions of 26
patients, sent to us by their pediatrician, through multidisciplinary
telematic meetings with dermatologists, rheumatological pediatricians,
infectious disease specialist. We only included patients with
pernio-like skin lesions (nine patients). We have excluded patients who
were unable to perform the swab before hospital admission, patients
whose parents did not obtain consent and patients with autoimmune
diseases. We collected informed consent to obtain clinical information
and photos of patients to be included in the study and to perform blood
chemistry sampling. Therefore, we evaluated 9 cases of children who were
referred to the Section of Pediatric Rheumatology, of General Pediatric
Unit, department of Human Pathology in Adulthood and Childhood “G.
Barresi”, University of Messina, since March to April 2020 during
outbreak of COVID-19. We have created a medical record in which we have
included demographic information on patients, family and personal
medical history, clinical manifestations and follow-up. We analyzed the
photos of these patients at the time of the onset of symptoms and we
assessed the cutaneous manifestations when they were admitted in the
outpatient setting of the hospital. They underwent blood chemistry: a
complete blood count (CBC), renal, hepatic, muscle function tests, urine
test, complement levels, immunoglobulins, coagulation studies
(prothrombin time, activated partial thromboplastin time, thrombin time
and D-dimer test), rheumatoid factor (FR), antinuclear antibodies (ANA),
extractable nuclear antigens (ENA), double stranded DNA (nDNA),
anti-topoisomerase I (anti- SCL70), antiphospholipid antibodies (aPL),
anti-cardiolipin (aCL), anti- β-2-glycoprotein 1(β2GP1), and Lupus
anticoagulant (LAC). In addiction, serology was performed using a
chemiluminescent microparticle immunoassay (CLIA) for detection of IgG
antibodies directed against the nucleocapsid protein of SARS-CoV2 and
IgM.