Article
Author: Kudo, Eriko ; Ko, Albert I. ; Nelson, Allison ; Courchaine, Edward ; Obaid, Abeer ; Ugwu, Nelson ; White, Elizabeth B. ; Rose, Kadi-Ann ; Prophet, Sarah ; Valdez, Jordan ; Klein, Rhonda Q. ; Glick, Laura ; Mekael, Dilgash ; Lu-Culligan, Alice ; Petrone, Mary ; McDonald, David ; Bickerton, Sean ; Watkins, Annie ; Shepard, Denise ; Iwasaki, Akiko ; Song, Eric ; Brower, Kristina ; Kalinich, Chaney ; Yildirim, Inci ; Smolgovsky, Mikhail ; Bermejo, Santos ; Nouws, Jessica ; Little, Alicia J. ; Minasyan, Maksym ; Todeasa, Codruta ; Sharma, Lokesh ; Batsu, Maria ; Nunez, Angela ; Campbell, Melissa ; Askenase, Michael H. ; Anastasio, Kelly ; Sonnert, Nicole ; Mao, Tianyang ; Ko, Christine J. ; Alpert, Tara ; Sewanan, Lorenzo ; Naushad, Nida ; Aguzzi, Adriano ; Rahming, Harold ; Yang, Yexin ; Park, Hong-Jai ; Wong, Patrick ; Muenker, Cate ; Silva, Erin ; McNiff, Jennifer ; Jaycox, Jillian ; Lim, Joseph ; Klein, Jon ; Kamath, Kathy ; Rice, Tyler ; Gehlhausen, Jeff R. ; Wang, Eric ; Harden, Christina ; Linehan, Melissa ; Patrignelli, Robert ; Antaya, Richard ; Khoury-Hanold, William ; Vijayakumar, Pavithra ; Nakahata, Maura ; Ring, Aaron M. ; Kim, Daniel ; Peng, Xiaohua ; Knaggs, Lynda ; Strong, Yvette ; Brito, Anderson ; Cao, Yiyun ; Fauver, Joseph ; DeIuliis, Giuseppe ; Lu, Peiwen ; Kuang, Maxine ; Matos, Irene ; Martinello, Rick ; Damsky, William ; Martin, Anjelica ; Lucas, Carolina ; Geng, Bertie ; Emmenegger, Marc ; Omer, Saad ; Velazquez, Sofia ; Datta, Rupak ; Jensen, Cole ; Simonov, Michael ; Handoko, Ryan ; Shon, John
An increased incidence of chilblains has been observed during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and attributed to viral infection. Direct evidence of this relationship has been limited, however, as most cases do not have molecular evidence of prior SARS-CoV-2 infection with PCR or antibodies. We enrolled a cohort of 23 patients who were diagnosed and managed as having SARS-CoV-2-associated skin eruptions (including 21 pandemic chilblains [PC]) during the first wave of the pandemic in Connecticut. Antibody responses were determined through endpoint titration enzyme-linked immunosorbent assay and serum epitope repertoire analysis. T cell responses to SARS-CoV-2 were assessed by T cell receptor sequencing and in vitro SARS-CoV-2 antigen-specific peptide stimulation assays. Immunohistochemical and PCR studies of PC biopsies and tissue microarrays for evidence of SARS-CoV-2 were performed. Among patients diagnosed and managed as "covid toes" during the pandemic, we find a percentage of prior SARS-CoV-2 infection (9.5%) that approximates background seroprevalence (8.5%) at the time. Immunohistochemistry studies suggest that SARS-CoV-2 staining in PC biopsies may not be from SARS-CoV-2. Our results do not support SARS-CoV-2 as the causative agent of pandemic chilblains; however, our study does not exclude the possibility of SARS-CoV-2 seronegative abortive infections.