10.5826/dpc.1302a75
text/xml
2160-9381
2612
en
Sajjad Barin
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
autoimmune disorders
Rapid Progression of Localized Morphea to Disseminated Plaque-Type Morphea Following COVID-19 Infection
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2023-04-29
2022-05-26
2023-04-29
2023-06-05
e2023075
Dermatol Pract Concept
Sajjad Barin
2023/04/29
10.5826/dpc.1302a75
e2023075
Department of Pathology, Ardabil University of Medical Sciences, Ardabil, Iran
2160-9381
autoimmune disorders
en
e2023075
Lotfi Z, Haghighi A, Akbarzadehpasha A, et al. Pansclerotic Morphea Following COVID-19: A Case Report and Review of Literature on Rheumatologic and Non-rheumatologic Dermatologic Immune-Mediated Disorders Induced by SARS-CoV-2. Front Med (Lausanne). 2021;;8:728411. DOI: 10.3389/fmed.2021.728411. PMID: 34746174. PMCID: PMC8564069.
Rapid Progression of Localized Morphea to Disseminated Plaque-Type Morphea Following COVID-19 Infection
https://dpcj.org/index.php/dpc/article/download/2612/2118
       Rapid Progression of Localized Morphea
   to Disseminated Plaque-Type Morphea Following
                 COVID-19 Infection
               Hoda Rahimi1, Leila Rezaie Shirmard2, Mehrdad Ashayer1, Sajjad Barin3


1 Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Pharmaceutics, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
3 Department of Pathology, Ardabil University of Medical Sciences, Ardabil, Iran



Key words: COVID-19, morphea, plaque, autoimmune disorders
Citation: Rahimi H, Rezaie Shirmard L, Ashayer M, Barin S. Rapid Progression of Localized Morphea to Disseminated Plaque-Type
Morphea Following COVID-19 Infection. Dermatol Pract Concept. 2023;13(2):e2023075. DOI: https://doi.org/10.5826/dpc.1302a75
Accepted: June 20, 2022; Published: April 2023
Copyright: ©2023 Rahimi et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Mehrdad Ashayer, MD, Dermatologist, Skin Research Center, Shahid Beheshti University of Medical Sciences,
Tehran, Iran. Shohada-e Tajrish Hospital, Shahrdari St, 1989934148, Tehran, Iran. Tel: +98-21- 22744394 E-mail: m.ashayer@yahoo.com




Introduction                                                             reported a single small lesion on her trunk from 1­year ago
                                                                         (which was neither enlarged nor distributed), so she did
Since the emerging of the SARS-CoV-2 pandemic, differ-                   not visit a physician. Seven months later, she was infected
ent COVID‐19‐associated manifestations have been re-                     with the SARS-CoV-2 virus, presenting with mild symp-
ported, involving nervous, hematologic, and endocrine                    toms (including myalgia, headache, and sore throat) with-
systems [1]. As the largest organ of the body, the skin has              out any lung involvement, which was confirmed by reverse
not been an ­exception and is reported to be involved in                 transcriptase–polymerase chain reaction (RT-PCR). She
COVID-19 p
         ­ atients with diverse manifestations, including                received palliative treatment in addition to ­azithromycin
­maculopapular, vesicular, lichenoid, urticarial, vasculitis, and        250mg/d for 1 week, and her symptoms were resolved
chilblain-like lesions [2,3]. Herein, we report a stable case of         without any sequel. After 2 months, her cutaneous lesion
localized morphea which progressed rapidly to disseminated               spread rapidly involving her trunk and lower extremities.
morphea following COVID-19 infection.                                    She did not have any systemic signs or symptoms. Her
                                                                         ­familial and personal history was negative for any auto-
Case Presentation                                                        immune disease.
                                                                              The physical examination revealed several brownish
A 45-year-old female patient was referred to our dermatol-               and violaceous plaques with firm ivory centers. The lesions
ogy clinic due to asymptomatic bilateral sclerotic cutane-               showed symmetrical and bilateral distribution, which tend
ous lesions on the trunk and lower extremities. The patient              to coalescence with islands of sparing normal skin (Figure 1).



Research Letter | Dermatol Pract Concept. 2023;13(2):e2023075                                                                        1
Figure 1. (A,B) Violaceous plaques with firm ivory centers tend to coalescence with islands of sparing normal skin on the trunk (A) and the
leg (B) of the patient.




Figure 2. Thickening of dermal collagen bundles running parallel to the skin surface (A) (H&E x4), with scattered, perivascular, and peri-
adnexal lymphoplasmacytic infiltration which extended into the hypodermis. Some eccrine glands appeared atrophic with few surrounding
adipocytes (B,C) (H&E x40).




2                                                                           Research Letter | Dermatol Pract Concept. 2023;13(2):e2023075
   A biopsy from one of her new leg lesions revealed thick-         due to the presence of a malignant neoplasm, the correlation
ening of dermal collagen bundles running parallel to the            between morphea and COVID-19 remains questionable. To
skin surface with scattered, perivascular, and periadnexal          the best of our knowledge, there is no report of the evolu-
lymphoplasmacytic infiltration, which extended into the             tion of localized-type morphea to disseminated plaque-type
­hypodermis. Some eccrine glands appeared atrophic with             ­morphea following COVID-19 infection in the literature.
few surrounding adipocytes, confirming the diagnosis of
morphea (Figure 2). Narrow-band UVB therapy started for
the patient, but she did not return for follow-up.
                                                                    References
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                                                                    2. Rahimi H, Tehranchinia Z. A Comprehensive Review of Cuta-
During    the   recent   SARS-CoV-2       pandemic,     different
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COVID‐19‐associated cutaneous disorders have been re-                  Int. 2020;2020:1236520. DOI: 10.1155/2020/1236520. PMID:
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important environmental trigger in the complex pathophysi-          3. Tehranchinia Z, Asadi-Kani Z, Rahimi H. Lichenoid eruptions
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                                                                       ated with COVID-19. Dermatol Ther. 2020;33(6):e13828. DOI:
of these systemic or cutaneous COVID‐19‐mediated diseases
                                                                       10.1111/dth.13828. PMID: 32542925. PMCID: PMC7323232.
are autoimmune disorders [1].
                                                                    4. Pigliacelli F, Pacifico A, Mariano M, et al. Morphea induced
   Among autoimmune connective tissue disorders, several               by SARS-CoV-2 infection: A case report. Int J D        ­ ermatol.
cases of new onset or deterioration of systemic lupus erythe-          2021;61(3):377-378. DOI: 10.1111/ijd.15983. PMID: 34783020.
matosus were reported as a consequence of COVID-19 [1].                PMCID: PMC8653008.
However, to date, there are only 2 cases of morphea reported        5. Lotfi Z, Haghighi A, Akbarzadehpasha A, et al. ­Pansclerotic
                                                                       Morphea Following COVID-19: A Case Report and R            ­ eview
in association with this infection. Pigliacelli et al reported
                                                                       of Literature on Rheumatologic and Non-rheumatologic
the onset of limited plaque morphea following SARS-CoV-2
                                                                       Dermatologic Immune-Mediated Disorders Induced by
infection for the first time [4]. The other case was reported          SARS-CoV-2. Front Med (Lausanne). 2021;;8:728411. DOI:
by Lotfi et al as pansclerotic morphea in a patient with lung          10.3389/fmed.2021.728411. PMID: 34746174. PMCID:
cancer and COVID-19 infection [5]. However, in this case,              PMC8564069.




Research Letter | Dermatol Pract Concept. 2023;13(2):e2023075                                                                           3
