A case of COVID-19 with papulovesicular rash that progressed to retiform purpura, accompanied by cherry angiomas

CONTEXT

Various skin manifestations have been reported in coronavirus disease. It may be difficult to determine the etiology of these lesions in view of the increased frequency of handwashing during the pandemic, along with occurrences of irritant contact dermatitis and allergic contact dermatitis due to disinfectant use; usage of herbal medicine and supplements to strengthen the immune system; and urticarial or maculopapular drug eruptions due to COVID-19 treatment. The variety of associated skin manifestations seen with COVID-19 makes it challenging to identify virus-specific skin manifestations. Petechiae, purpura, acrocyanosis and necrotic and non-necrotic purpura, which can be considered as manifestations of vascular involvement on the skin, have been reported.

CASE REPORT

Here, we report a case of eruptive cherry angiomas, which was thought to have developed due to COVID-19, with a papulovesicular rash on distal extremities that progressed over time to reticular purpura.

CONCLUSION

The case presented had a papulovesicular rash at the onset, which evolved to retiform purpura, and eruptive cherry angiomas were observed. It should be kept in mind that dermatological signs may vary in patients with COVID-19.

[Cloning and expression of gp85 gene of subgroup J avian leukosis virus isolated from hemangiomas]

During July to November in 2007, several outbreaks of Hemangiomas in Hy-line Brown laying hens were observed in China. The virus that infected these flocks was identified in cultured DF-1 cells by PCR and indirect fluorescent assay (IFA) with ALV-J specific monoclonal antibody JE-9. The gp85 gene of one strain named WS0705 of ALV-J was cloned and expressed. Phylogenetic analysis showed that gp85 amino sequences of WS0705 strain had the highest homology with that of the prototype HPRS-103. The gp85 gene from a constructed plasmid pMD18-T-WS0705gp85 was cloned into baculovirus transfer vector. rBac-WS0705gp85 was obtained by the Bac-to-Bac baculovirus expression system. The rBac-WS0705gp85 protein was analyzed by indirect immunofluor escence assay and Western blot. The results showed that positive green fluorescent was present in Sf9 cells infected with the recombinant virus and a 35 kD band was present in western blot. It is concluded that WS0705 gp85 gene was expressed in Sf9 cells infected with the recombinant virus and the SU protein of WS0705 can bind specifically to JE9 MAb of ALV-J. The expressed protein can be used to detect hemangiomas induced by ALV-J.

[Full-length cDNA sequence analysis of avian leukosis viruses subgroup J isolated from chickens with clinical hemangioma]

OBJECTIVE

To understand the molecular characteristics of subgroup J Avian Leukosis Viruses (ALV-J) isolated from chickens with clinical hemangioma, as well as to get more information for controlling the spread of ALV-J in layer chickens flocks.

METHOD

We amplified the full-length viral cDNA sequences of three layers isolates associated with simple hemangioma or coexisting of hemangioma and myeloid leukosis (ML) by PCR. We also obtained some partial sequences of three layer isolates related to hemangioma and one layer isolate from ML case. Then we analyzed and compared the sequences by using DNAstar software.

RESULTS

The phylogentic analysis showed the significant differences in the complete sequences between isolates from layer hemangioma cases and from broilers, which were grouped to two branches in the phylogenetic tree. We noted a special 19bp insertion mutation in Primer Binding Site (PBS)-Leader sequences in both JS09GY3 and JS09GY6 isolates from layer chickens with hemangioma and ML, which sequence was same to Rous Associated Virus type 1 (RAV-1), Rous Associated Virus type 2 (RAV-2) and Rous sarcoma virus (strain Schmidt-Ruppin B) (RSV-SRB). In addition, different continuous sequences deletions were found in the U3 regions of NHH and JS09GY5. By motif analysis, we found some distinct motifs including c-Est-1, TCF11 and C/EBP only in the isolates from layers with hemangioma. The five isolates associated with layer hemangioma exhibited intact E element sequences but almost identical substantial deletion was found in all Chinese broiler isolates. An 11bp continuous nucleotide insertion in the E element of JS09GY3 was found.

CONCLUSION

Isolates from layer showing hemangioma and broilers exhibited evident difference. We found some special mutation sites in U3, DR1 and the E element showed some potential relationship with the host breeds and the tumor phenotype, which function needs to be investigated in future. The isolates from layer cases with coexisting of hemangioma and ML were the recombinants of ALV-J and other retroviruses.

Polyoma virus middle-T-transformed PECAM-1 deficient mouse brain endothelial cells proliferate rapidly in culture and form hemangiomas in mice

Wild-type mouse brain endothelial (bEND) cells transformed with the polyoma virus middle-T proliferate rapidly in culture and form hemangiomas in mice. These cells express high levels of platelet/endothelial cell adhesion molecule-1 (PECAM-1), a molecule shown to be important during hemangioma formation. In this study, we have examined the ability of polyoma virus middle-T-transformed mouse bEND cells prepared from PECAM-1-/- mice to proliferate in culture and form hemangiomas in mice. We show that these cells express a number of endothelial cell markers and share a similar morphology with PECAM-1+/+ bEND cells. PECAM-1-/- bEND cells exhibit a limited ability to form tubes in Matrigel and rapidly form hemangioma when injected into nude mice, very similar to PECAM-1+/+ bEND cells. These cells, however, have increased proliferation, slower migration, altered endothelial cell adhesion molecule expression, and are less adherent when compared to PECAM-1+/+ bEND cells. Therefore, lack of PECAM-1 expression impacts polyoma middle-T-transformed endothelial cell proliferative, adhesive, and migratory properties without impacting their ability to rapidly form hemangiomas in mice or poorly organize to capillary-like structures in Matrigel.

A novel animal model for hemangiomas: inhibition of hemangioma development by the angiogenesis inhibitor TNP-470

Hemangiomas represent the most frequent tumors of infancy. However, the pathogenesis of these tumors is still largely unknown, and current treatment of juvenile hemangiomas remains unsatisfactory. Here we present a novel animal model to study proliferating hemangiomas and to evaluate the effect of angiostatic compounds on their growth. Intraperitoneal (i.p.) infection of 4-day-old rats with murine polyomavirus resulted in the development of multiple cutaneous, intramuscular (i.m.), and cerebral hemangiomas with 100% frequency. Histological examination of the brain revealed the formation of immature lesions as soon as 4 days postinfection (p.i.). The subsequent exponential growth of the hemangiomas, both in number and size, was associated with severe hemorrhage and anemia. The cerebral, cutaneous, and i.m. lesions consisted of blood-filled cysts, histologically similar to human cavernous hemangiomas and stained positive for proliferating cell nuclear antigen, urokinase-type plasminogen activator, and vascular endothelial growth factor. Mature cerebral hemangiomas also expressed von Willebrand factor. Cerebral lesions caused death of the untreated animals within 19.2 +/- 1.1 days p.i. Remarkably fewer and smaller hemangiomas developed in animals that had been treated s.c. with the angiogenesis inhibitor TNP-470. Accordingly, TNP-470 (50 mg/kg), administered twice a week from 3 days p.i., significantly delayed tumor-associated mortality [mean day of death, 28.2 +/- 3.3 (P < 0.001)]. Even if therapy was initiated when cerebral hemangiomas were already macroscopically visible (i.e., 9 days p.i.), a significant delay in hemangioma-associated mortality was observed. Also, the IFN-inducer polyinosinic-polycytidylic acid caused a delay of 9 days (P < 0.005) in tumor-associated mortality when administered i.p. at 5 mg/kg, twice a week, starting at day 3 p.i. The model described here may be useful for investigating (a) the angiogenic mechanism(s) underlying hemangioma progression; and (b) the effect of anti-angiogenic compounds on vascular tumor growth.

Potent inhibition of hemangioma formation in rats by the acyclic nucleoside phosphonate analogue cidofovir

The acyclic nucleoside phosphonate analogue cidofovir elicited a marked protection against hemangioma growth in newborn rats that had been infected i.p. with a high titer of murine polyomavirus. Untreated, infected rats developed cutaneous, i.m., and cerebral hemangiomas associated with severe hemorrhage and anemia leading to death within 3 weeks postinfection (p.i.). s.c. treatment with cidofovir at 25 mg/kg, once a week, resulted in a complete suppression of hemangioma development and associated mortality when treatment was initiated at 3 days p.i. (100% survival compared with 0% for the untreated animals). Cidofovir still afforded 40% survival and a significant delay in tumor-associated mortality when treatment was started at a time at which cerebral hemangiomas were already macroscopically visible (i.e., 9 days p.i.). Infectious virus or viral DNA was undetectable in the brain at different times p.i. as assessed by means of (a) a DNA-DNA hybridization assay and (b) titration of the brain for infectious virus content, indicating that there was no viral replication in murine polyomavirus-infected rats. Moreover, a semiquantitative PCR for viral protein 1 DNA revealed that the amount of viral protein 1 DNA declined with time after infection to become virtually undetectable at 18 days p.i. Therefore, an antitumor or antiangiogenic effect, rather than inhibition of viral replication, may be the reason for the inhibitory activity of cidofovir in this model. Cidofovir may thus be further explored for the treatment of vascular tumors and, in particular, life-threatening juvenile hemangiomas.

Absence of human herpesvirus 8 DNA sequences in vascular tumors of the liver

Kaposi's sarcoma-associated herpes virus (KSHV), also designated human herpesvirus 8 (HHV8), has been detected consistently in Kaposi's sarcoma, body cavity lymphoma and multicentric Castleman's disease, both in human immunodeficiency virus (HIV)-positive and -negative patients. Identification of KSHV/HHV8 DNA sequences in various benign and malignant vascular tumors in HIV-negative patients was reported in one study, but was not confirmed in several other studies. The vascular lesions, other than Kaposi's sarcoma, in which sequences could not be detected have included malignant vascular tumors of serous membranes, infantile capillary hemangiomas, and several benign and malignant vascular tumors of the spleen. We studied 30 primary benign and malignant vascular tumors of the liver; KSHV/HHV8 DNA sequences could not be detected in any. We conclude that this virus plays no role in the etiology of vascular tumors of the liver.

[Absence of HHV-8 virus detected in immature hemangiomas in infants]

INTRODUCTION

The aim of our study was to search for the presence of HHV-8 DNA sequences in Biopsy specimens from hemangioma of the infancy.

MATERIAL AND METHODS

The study included 9 biopsies from hemangioma. DNA of human beta-globin gene and HHV-8 were searched for by PCR using specific primers. Amplified products were revealed after an hybridization with an internal probe digoxigenin-labelled.

RESULTS

Human beta-globin gene could be detected in all samples illustrating the absence of PCR inhibitor. HHV-8 could never be detected in samples analyzed.

DISCUSSION

Our study does not imply any causative role of HHV-8 in the pathogenesis of hemangioma. This result must be confirmed by serologic studies.

Splenic vascular tumors: a histologic, immunophenotypic, and virologic study

Vascular tumors of the spleen include several different entities, some of which are unique to that organ. Twenty-two such proliferations were studied, including 10 hemangiomas, six littoral cell angiomas, four angiosarcomas, and two hamartomas. The hemangiomas included seven with localized tumors and three with diffuse angiomatosis of the spleen. All cases were studied by paraffin section immunohistochemistry with a large panel of antibodies. In addition, all cases were studied for the presence of the Kaposi's sarcoma-associated herpesvirus (KSHV) using the polymerase chain reaction. The morphologic findings were similar to those previously reported. All proliferations were vimentin positive, and one angiosarcoma was focally keratin positive. All cases reacted for CD31, whereas 20 of 22 were positive for von Willebrand's factor and 19 of 22 were positive for Ulex europeaus. CD34 expression in lining cells was identified in 10 of 10 hemangiomas, two of four angiosarcomas, and one of two hamartomas, whereas all six cases of littoral cell angioma were negative. CD68 was expressed in all cases of littoral cell angioma but was also positive in all three diffuse hemangiomas, two of seven localized hemangiomas, and two of four angiosarcomas. CD21 expression was restricted to the lining cells of littoral cell angioma, and CD8 expression was only identified in two of two hamartomas and two of four angiosarcomas. KSHV was not detected in any of the cases. These findings suggest that there are distinct immunophenotypic as well as morphologic features of splenic vascular tumors. Littoral cell angiomas have a characteristic CD34-/CD68+/CD21+/CD8- immunophenotype and hamartomas have a characteristic CD68-/CD21-/CD8+ phenotype. The frequent CD68 expression in diffuse hemangioma suggests an immunophenotypic difference from localized hemangioma of the spleen.

Programmed endothelial cell death induced by an avian hemangioma retrovirus is density dependent

Hemangiomas are localized tumors of vascular cells which appear frequently in humans and animals, and their mode of induction is unknown. Recently, a new field strain of avian retrovirus, avian hemangioma virus (AHV), was isolated from spontaneous hemangiomas in layer hens. Sequence analysis of the AHV genome revealed the presence of three prototypic retroviral genes, gag, pol, and env, but no oncogenes. AHV was capable of inducing hemangiomas in hens in vivo, but it induced a strong cytopathic effect in cultured endothelial cells. The AHV envelope glycoprotein, gp85, was found to be responsible for the cell-killing effect. Four independent lines of experimental evidence indicated that AHV induces a cytopathic effect through a typical programmed cell death, apoptosis: (i) morphological changes in cells visualized by light microscopy, (ii) nuclear condensation and fragmentation indicated by 4',6-diamidino-2- phenylindole staining, (iii) intranucleosomal degradation of DNA demonstrated by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling staining, and (iv) flow cytometry analysis of the DNA content of the infected cells. Quiescent endothelial G0/G1 cells were much more sensitive to AHV-induced apoptosis than actively dividing cells, suggesting that the AHV ability to induce apoptosis is dependent on the proliferative state of the infected cells.