By vgreene, 24 August, 2020

Title

(BMJ)—A 42-yo healthy man presented w/ a 15-day hx of fever, headache, and fatigue, and 7 days of dry cough. Painful lesions were present on both lower legs for 3 days. Fevers continued despite abx. Exam: tender, violaceous nodules on bilat shins, otherwise normal. Labs: elevated LFTs, lymphopenia, blood cx/hepatitis/HIV neg. What is the dx?
Systemic lupus erythematosus
Sarcoidosis
COVID-19 infxn
Familial Mediterranean fever
Erysipelas
You are correct. A nasopharyngeal swab confirmed the dx of COVID-19. The dermatologist found the pink, blanching, tender subcutaneous nodules on both shins to be most consistent w/ erythema nodosum (EN). No bx was performed, due to the high clinical suspicion. Viral infxn is commonly identified as the etiology of EN and mainly includes infectious mononucleosis, hepatitis B and C, HIV, HSV, and Epstein-Barr virus. Strep infxns and paravaccinia virus are other common causes. EN assoc w/ fever, cough, and SOB may be attributed to a COVID-19–assoc skin rash. The pt was treated w/ topical steroids and compression stockings. Sx disappeared almost completely after 2wk of local tx.

BMJ Case Reports CP 2020;13:e236613.