Does sensitization by SARS-CoV-2 immune complexes trigger DRESS syndrome?

Area of Science:

• Infectious Diseases
• Dermatology
• Hepatology

Background:

• Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents diagnostic challenges due to multi-organ involvement.
• SARS-CoV-2 infection can trigger intense inflammatory and autoimmune responses, leading to diverse clinical manifestations beyond the respiratory system.
• Pre-existing comorbidities and medication history, such as carbamazepine use, may influence disease severity and presentation.

Observation:

• A 36-year-old male patient with comorbidities and a history of carbamazepine use developed a severe COVID-19 illness.
• The patient exhibited extensive exfoliative erythroderma, a significant skin manifestation.
• Severe impairment of liver function was observed as a critical complication.

Findings:

• The case highlights a severe, prolonged (approximately 80 days) manifestation of COVID-19 involving both dermatological and hepatic systems.
• The combination of exfoliative erythroderma and severe liver dysfunction underscores the potential for COVID-19 to induce widespread systemic inflammatory effects.
• This presentation suggests a complex interplay between SARS-CoV-2 infection, host immune response, and potential medication interactions.

Implications:

• Clinicians should consider a broad spectrum of organ involvement in COVID-19 diagnosis and management, including severe dermatological and hepatic complications.
• This case emphasizes the need for vigilant monitoring of liver function and skin integrity in patients with severe COVID-19, particularly those with risk factors.
• Further research is warranted to elucidate the mechanisms underlying these severe extra-pulmonary manifestations of COVID-19 and their long-term consequences.