As the number of cases increases worldwide, a wide range of cases were reported with a set of common symptoms. The known symptoms are listed as cough, fever, vomiting, diarrhea, wheezing, or dyspnea. It was aim to report a case of COVID-19 with a unique symptoms of rash on the lips that did not have fever, respiration problems or cough.
A 37 years old male patient presented to Emergency Clinic of Kafkas University Research and Training Hospital, Kars Turkey with a complain regarding to exhaustion and sore throat.
However, the patient had an unusual lip and nose rash for which further evaluations were conducted by a dermatologist. Many symptoms and signs can be seen in patients with Covid 19. We wanted to draw attention to the possibility of rash in body parts.
COVID-19, herpes virus, symptoms
The ongoing global pandemic of the novel coronavirus disease 2019 (COVID-19) was initially reported in Wuhan, China and subsequently spread worldwide [1]. After the infection, the virus manifest itself as an atypical pneumonia with a higher mortality rate among elderly [2]. As the number of cases increases worldwide, a wide range of cases were reported with a set of common symptoms [3]. One of the major problems regarding the global pandemic is asymptomatic cases that are deemed healthy and act as carriers [4,5]. The known symptoms are listed as cough, fever, vomiting, diarrhea, wheezing, or dyspnea [6]. However, we did detect a case of COVID 19 with a unique symptoms of rash on the lips that did not have fever or cough. The dermatological evaluations of the apparent rash indicated oral herpes infection caused by the herpes simplex virus.
It was aim to report a case of COVID-19 with a unique symptoms of rash on the lips that did not have fever, respiration problems or cough.
As March 25, 2020, a 37 years old male patient presented to Emergency Clinic of Kafkas University Research and Training Hospital, Kars Turkey with a complain regarding to exhaustion and sore throat. Upon the admission to the hospital, we conducted a number of routine tests for the patient. The axillary temperature of 36.3°C, a pulse of 80, and a breath per min rate of 12 were recorded. The patient’s oxygen saturation was at 95%. Laboratory examination showed a total white blood cell count of 3.2×10⁹ cells per L, an absolute neutrophil count of 1.3×10⁹ per L, a lymphocyte cell count of 0.95×10⁹ cell per L, platelet counts of 0.164×10⁹ cells per L, and a hemoglobin concentration of 156 g/L. The patient’s serum C-reactive was 0.328 mg/dL. He did not have any other reported symptoms of COVID-19, no fever was reported, no elevated temperature was measured or no gastrointestinal or respiratory symptoms that were associated with COVID 19 were present, including cough, vomiting, diarrhea, wheezing, or dyspnea.
The only apparent complain was exhaustion and sour throat. Due to the fact that all the cases presented to emergency room with the sour throat are subjected to the CT scan, the current patient went through CT scanning. Chest CT images on Mart 25 and 26 showed abnormalities (Figure 1a) and the patient was moved to the contained section. The nasopharyngeal swabs were subsequently collected and COVID-19 was confirmed with real-time RT-PCR on March 27, 2020. The patient was then transferred to designated COVID-19 unit at Kafkas University Research and Training Hospital. However, the patient had an unusual lip and nose rash for which further evaluations were conducted by a dermatologist (Figure 1b).
Figure 1. CT image of the case showing lung involvement (a) and lip picture indicating manifestation of the herpes simplex during COVID-19 (b)
We immediately gathered information on possible routes of infection. The patent was living with his family in Kars. He was working at a local school until recent nationwide break. At the first two days of case, no one in the immediate family or in contact environment had positive results implying a potential infection source. The patient did not have any travel history or a direct contact with anyone with a recent travel history. Nonetheless, three days later a neighbor living in the upstairs (with no direct contact) was hospitalized and reported to be positive for COVID-19. The neighbor reportedly had a recent travel to Cyprus and appears to be the source of infection.
The patient presented here indicated only a subset of the previously described symptoms in the form of a sour throat and exhaustion. The case did not have fever as widely reported. However, the patient has an unusual herpes virus infection in the lips. The dermatological evaluations of the apparent rash indicated oral herpes infection caused by the herpes simplex virus.
The novel COVID-19 in the case reported here appears to have weakened the immune system and thus triggered the manifestation of the herpes virus [7]. The source of infection seems to be a neighbor living in the same building who had a recent international travel to Cyprus. As this case present a unique set of presentation of this global epidemic, a larger set of cases will help to better assess the entire spectrum of symptoms of Covid-19.
Many symptoms and signs can be seen in patients with Covid 19. We wanted to draw attention to the possibility of rash in body parts.
We would like to thank our patient and his family for allowing us to use patient data in our article.
T.D is the main author. L.S.D.B, Z.K, and H.F.G co-authors.
All authors were involved in majority of writing this article which includes the patient summary, literature search and the discussion.
The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
The author(s) received no financial support for the research, authorship and/or publication of this article.
This study did not involved in patient’s management and treatment.
The patient filled and signed separate document and obtained.
- WHO. Pneumonia of unknown cause – China [Internet]. WHO. World Health Organization; [cited 2020 Mar 29]. Available from: http://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/
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- Bai Y, Yao L, Wei T, Tian F, Jin D, et al. (2020) Presumed asymptomatic carrier transmission of COVID-19. Jama 323(14): 1406-1407. [Crossref]
- Rothan HA, Byrareddy SN (2020) The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of Autoimmunity 109: 102433. [Crossref]
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