Introduction
Delayed-type drug hypersensitivity reactions (DDH) result from T
cell-mediated immune responses against drugs (Gell and Coombs type IV
allergic reaction)1. DDH
affect about 7% of the general
population2,3.
The most common DDH are maculopapular drug exanthemas (maculopapular
drug rashes ; MDR), which are typically mild reactions that are limited
to the skin and controllable with topical
corticosteroids4. In
contrast, severe cutaneous hypersensitivity reactions are rare, but
life-threatening when they occur. Drug reaction with eosinophilia and
systemic symptoms (DRESS) belongs to the category of severe
DDH5.
Since the beginning of the Coronavirus disease 19 (COVID-19)
pandemic6,
different types of DDH have been reported in severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2)-infected
patients7, raising the
question as to how COVID-19 is associated with their development. We and
others have reported glucocorticoid-refractory severe DRESS with massive
eosinophilia in COVID-19
patients8,9.
Besides DDH, other cutaneous eruptions have been associated with
SARS-CoV-2 infection and have been observed in approximately 1-20 % of
the patients10-15.
These various skin manifestations of SARS-CoV-2
infection16,17may be due in part to the SARS-CoV-2 spike protein receptor
(angiotensin-converting enzyme 2, ACE2) being expressed by
keratinocytes17Supporting this possibility is the finding that SARS-CoV-2 RNA can be
directly isolated from the skin of some COVID19
patients18.
Here we report a series of MDR cases in severely ill COVID-19 patients
and sought to address how MDR occurring in COVID-19 patients (COVID-MDR)
differs from MDR not related to COVID, and DRESS.