Complete blood count, ESR, and comprehensive metabolic profile were unremarkable. and exposed erythema and slight edema of the right dorsal toes and localized violaceous vesicular changes in the right plantar foot (Fig.?1a,b). Radiograph performed exposed no osseous abnormality. The patient was diagnosed with soft tissue changes related to trauma. Open in a separate window Number 1 (a) Erythema and slight edema of the toes; (b) localized violaceous vesicular changes The second telehealth Digoxin check out was performed because of ongoing skin changes, now involving both feet. The patient reported minimal pain and slight pruritus. The lesions visualized on video were progressively violaceous and involved the plantar ft in addition to toes. Subsequent photos exposed chilblains\like changes in your toes (Fig.?2a,b). There were violaceous lesions and erosions within the dorsal toes. Owing to concerns for skin manifestation of COVID\19 or other systemic disease, a Pediatric Dermatology electronic consultation was performed. Open in a separate window Physique 2 (a) Chilblains\like violaceous changes in the dorsal toes; (b) plantar foot with violaceous Digoxin macules and erosion Pediatric Dermatology recommended additional blood work and agreed with testing for COVID\19. Complete blood count, ESR, and comprehensive metabolic profile were unremarkable. EBV antibody profile was unfavorable. Nasopharyngeal swab for SARS\CoV\2 PCR was unfavorable. Serum SARS\CoV\2 IgG antibodies were positive. Of note, the patient denied fever or respiratory symptoms. The most recent infectious symptoms occurred approximately 2?months prior when the patient was seen in the emergency department for fever, pharyngitis, and cough. Streptococcal testing and influenza testing were performed and found unfavorable. COVID\19 has become a pandemic condition, and dermatologic manifestations are being increasingly described. There have been reports of transient livedo reticularis, urticarial\like, vesicular, and dengue fever\like eruptions, which tend Digoxin to occur during contamination. 1 , 2 , 3 , 4 Recently, reddish\purple lesions around the distal fingers and toes, similar in appearance to perniosis (chilblains), have been described in patients with documented or Digoxin suspected COVID\19. 5 , 6 It has been hypothesized that these lesions could be a late manifestation of COVID\19, supported by the fact that some of the patients reported symptoms or contact with higher\risk individuals weeks Digoxin prior to the appearance of these skin lesions but lacked serologic testing. 6 , 7 Indeed in our patient, presently there was a history of a febrile illness approximately 6? weeks prior to the Rabbit Polyclonal to TRIM16 onset of the skin lesions. The fact that our patient tested positive for COVID\19 IgG and unfavorable for PCR also supports the hypothesis of these chilblains\like lesions being a delayed presentation. In future patients presenting with these types of lesions, we recommend inquiring about exposure to COVID\19 contacts, presence of COVID\type symptoms in weeks prior, and if possible, pursuing serological testing. Additionally, our case highlights the use of multidisciplinary virtual care aiding in the diagnosis. As evidenced by this case as well as other reports from the literature, chilblains\like violaceous skin lesions of acral sites can represent a delayed manifestation of COVID\19. Antibody testing may assist with confirming prior exposure and/or aid in contact tracing. This case also demonstrates the effectiveness of telehealth to provide high\quality multidisciplinary care while maintaining patient and staff safety. Notes Conflict of interest: None. Funding source: None..