Chilblain-like acral lesions in long COVID-19: management and implications for understanding microangiopathy, 2021, Mehta et al

We read with interest the Comment by Devon E McMahon and colleagues 1 describing the range of cutaneous manifestations of COVID-19. We agree that most acral chilblain-like or pernio-like lesions (commonly referred to as COVID toes) occur in young, previously healthy patients with relatively mild COVID-19 and frequently negative tests for SARS-CoV-2. Most resolve spontaneously without any treatment approximately 2 weeks from onset, particularly in children and adolescent patients. However, in our multidisciplinary post-COVID-19 follow-up clinic of adult patients and specialist tertiary referral centre for paediatric and adolescent rheumatology, we have observed a subgroup of patients with persistent chilblain lesions, similar to McMahon and colleagues' report.

Open access, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00133-X/fulltext

 

The similarities between long Covid and my symptoms are getting a bit freaky. I'm beginning to think I might be having long Covid since long before it was "invented".*

Anyway. Chilblain-like lesions aren't a common(ly mentioned?) ME symptom but I do get them, mostly on the fingers but also the occasional toe. Plus other manifestations of microvascular problems. This only started many years into ME so could simply be a downstream problem.

On the other hand there may have been endothelial injury from the get go - a number of viruses seem to be able to do this - only not severe enough to cause clearly visible symptoms from the beginning.

Microvascular and endothelial issues in ME seem to pop up briefly every now and then in ME research but are never fully investigated. Much like everything else in this disease.

*Actually, I'm only half joking. The 2012 virus that preceded my current relapse was never tested (of course) but there was talk at the time that there was a lot of enterovirus and coronavirus (one of the old endemic ones) going around so who's to say there isn't a Covid12?