Background: the most commonly reported clinical manifestations of Coronavirus Disease (COVID- 19) are: fever, fatigue, dry cough, anorexia, myalgias, dyspnoea and sputum production. Other, rarer, manifestations include headache, sore throat, rhinorrhoea, nausea, diarrhoea and olfactory or taste disorders. Two recent small-scale studies suggest the possibility of a skin rash being a clinical presentation of the disease. The purpose of our case report is to bring attention to an atypical presentation of the disease (skin rash) and reflect on the importance of the correct identification of COVID-19 suspicious symptoms as part of the crucial activity of case-finding in primary care.
Case presentation: the patient is an Italian 32 years old female nurse who has had several close contacts to COVID-19 cases during her working shifts. On the 13 th March 2020 she developed an itchy erythematous papular rash sparing only her sparing only her face, scalp and abdomen. One week later she developed fever and diarrhoea. During the first week of remote assessment carried out by her General Practitioner (GP), she gradually developed a dry cough, intermittent fever and diarrhoea. At the time of article submission (31 days after the symptoms onset), she has not completely recovered and is still suffering of a dry cough, headache, fatigue and, occasionally, diarrhoea.
Conclusions: this study suggest that skin manifestations could be an early presentation of COVID-19 and, during outbreaks, they should be taken into proper account by primary care providers as possibly caused by Sars-Cov-2. Early identification of COVID-19 patients is a crucial part of the strategy of case detection and case isolation, which has shown to be crucial in the reduction of incidence and COVID-19-related mortality. Further research is needed to establish frequency, symptoms, signs, pathogenesis and role in case detection of skin manifestations in COVID-19 patients.