Female patient, 55 years old, intensive care physician, resident of the city of Recife—PE. She has hypothyroidism and overweight comorbidities. The patient had contact with an intensive care unit (ICU) patient previously tested positive for Sars-cov-2 on 03/22/2020. Five days later, few painful erythematous-edematous plaques appeared on the flexor face of forearms and leg extensors (picture 1). Some lesions evolved into bruises. She was treated with betamethasone cream 0.1% once a day with lesion resolution in 3 days.
The patient had a second exposure to another ICU patient with COVID-19 on 04/05/2020. On 06/04/20, she had a fever, epistaxis, headache, myalgia, vomiting, and diarrhea. In the skin, she presented pruritic urticarial lesions on the shoulders and inguinal region (Fig. 1). On the palms of his hands, there was erythema and intense itching (Fig. 2).
She was medicated with Bilastine 20 mg one tablet a day for 15 days. Within 48 h, there were no more wheals and erythematous-edematous plaques appeared without itching in the antecubital and popliteal fossae (Fig. 3). The lesions regressed after the use of betamethasone ointment 0.1% cream once a day for 2 days. On 12/04/2020, the patient presented anosmia, nasal obstruction, asthenia, and mild dyspnea. However, no return of skin lesions. The laboratory showed a positive polymerase chain reaction for |Sars-cov-2 and results within normality; lactate dehydrogenase: 321 u/l, C-reactive protein (CPR): 0.7 mg/L, fibrinogen: 304 mg/dL, International Normalized Ratio: 1.00, troponin: 0.03 ng/mL, d-dimer: 400 µg/L, total leukocytes: 6890/mm, neutrophils: 4078, eosinophils: 48, lymphocytes: 1897, platelets: 234.000/mm3, alanine aminotransferase: 42 pg/mL, aspartate aminotransferase: 31 U/L, total bilirubin: 0.5 mg/dL, serum creatinine: 0,73 mg/dL and. She used only oral zinc and was completely recovered after 10 days of the onset of systemic symptoms.