Response to ‘No evidence of SARS‐CoV‐2 infection by polymerase chain reaction or serology in children with pseudo‐chilblain’. Reply from the authors

Caselli, D.; Chironna, M.; Loconsole, D.; Aricò, M.

Dear Editor, Recalcati et al. conclude that chilblain‐like lesions (CLLs) are part of the spectrum of COVID‐19 based on reports of SARS‐CoV‐2 in endothelial cells of skin biopsies assessed by immunohistochemistry and electron microscopy (EM).(1) Nevertheless, the conclusion does not seem to be adequately supported by the data. Recalcati et al. expand their previously reported case series to include 32 patients with CLLs. In 21 of 32 cases, no nasopharyngeal swab (NPS) was tested for SARS‐CoV‐2. Two of 11 patients subjected to molecular testing were positive for SARS‐CoV‐2, but no serological test was performed to verify the seroconversion. Three patients tested positive for IgM and negative for IgG antibodies without any confirmation of infection through NPS.