Eruptions and Related Clinical Course Among 296 Hospitalized Adults with Confirmed COVID-19

Rekhtman, Sergey; Tannenbaum, Rachel; Strunk, Andrew; Birabaharan, Morgan; Wright, Shari; Grbic, Nicole; Joseph, Ashna; Lin, Stephanie K.; Zhang, Aaron C.; Lee, Eric C.; Rivera, Erika; Qiu, Michael; Chelico, John; Garg, Amit

Background Limited information exists on mucocutaneous disease and its relation to course of COVID-19. Objective To estimate prevalence of mucocutaneous findings, characterize morphologic patterns, and describe relationship to course in hospitalized adults with COVID-19. Methods Prospective cohort study at two tertiary hospitals (Northwell Health) between May 11, 2020 and June 15, 2020. Results Among 296 hospitalized adults with COVID-19, 35 (11.8%) had at least one disease-related eruption. Patterns included ulcer (13/35, 37.1%), purpura (9/35, 25.7%), necrosis (5/35, 14.3%), non-specific erythema (4/35, 11.4%), morbilliform eruption (4/35, 11.4%), pernio-like lesions (4/35, 11.4%), and vesicles (1/35, 2.9%). Patterns also demonstrated anatomic site-specificity. A greater proportion of patients with mucocutaneous findings used mechanical ventilation [61% vs. 30%], used vasopressors [77% vs. 33%], initiated dialysis [31% vs. 9%], had thrombosis [17% vs. 11%], and had in-hospital mortality [34% vs. 12%] compared to those without mucocutaneous findings. Patients with mucocutaneous disease were more likely to use mechanical ventilation [adjusted PR 1.98 (1.37-2.86); P<0.001]. Differences for other outcomes were attenuated after covariate adjustment and did not reach statistical significance. Limitations Skin biopsies were not performed. Conclusions Distinct mucocutaneous patterns were identified in hospitalized adults with COVID-19. Mucocutaneous disease may be linked to more severe clinical course.