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The Pathological Culprit of Neuropathic Skin Pain in Long COVID-19 Patients: A Case Series

Cutaneous neurosensory symptoms have become increasingly reported findings in COVID-19; however, these virus-related manifestations are largely overlooked, and their pathology is poorly understood. Moreover, alterations of skin sensibility currently recognize no clear histopathology substrate. The p...

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Autores principales: Grieco, Teresa, Gomes, Vito, Rossi, Alfredo, Cantisani, Carmen, Greco, Maria Elisabetta, Rossi, Giovanni, Sernicola, Alvise, Pellacani, Giovanni
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9369885/
https://www.ncbi.nlm.nih.gov/pubmed/35956094
http://dx.doi.org/10.3390/jcm11154474
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author Grieco, Teresa
Gomes, Vito
Rossi, Alfredo
Cantisani, Carmen
Greco, Maria Elisabetta
Rossi, Giovanni
Sernicola, Alvise
Pellacani, Giovanni
author_facet Grieco, Teresa
Gomes, Vito
Rossi, Alfredo
Cantisani, Carmen
Greco, Maria Elisabetta
Rossi, Giovanni
Sernicola, Alvise
Pellacani, Giovanni
author_sort Grieco, Teresa
collection PubMed
description Cutaneous neurosensory symptoms have become increasingly reported findings in COVID-19; however, these virus-related manifestations are largely overlooked, and their pathology is poorly understood. Moreover, alterations of skin sensibility currently recognize no clear histopathology substrate. The purpose of this study was to provide pathology evidence of neurosensory skin system involvement in COVID-19 patients complaining of subjective neurological symptoms affecting the skin. Out of 142 patients, six long COVID-19 cases complaining of cutaneous subjective neurological symptoms assessed on an NTSS-6 questionnaire underwent histopathological and immunohistochemical analyses of skin areas affected by paroxysmal diffuse burning and itching sensations. Two patients also performed electroneurography examination. The histology investigation showed hypertrophic glomus vascular bodies with hypertrophic S100+ perineural sheath cells and adjacent hypertrophy of the nerve branches associated with increased basophil polysaccharide matrix. Electroneurography revealed disturbances of A-delta and C dermal neuronal fibers. The main limitation of this study consisted of a limited number of skin biopsy samples, requiring further investigation. Histopathology findings are consistent with hypertrophy of nerve endings, suggesting a condition such as “dermal hyperneury”, a recently reported small nerve hypertrophy condition affecting sensory C fibers. Such a neuropathic basis could explain dysesthesia experienced by the patients, as previously described in postherpetic neuralgia.
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spelling pubmed-93698852022-08-12 The Pathological Culprit of Neuropathic Skin Pain in Long COVID-19 Patients: A Case Series Grieco, Teresa Gomes, Vito Rossi, Alfredo Cantisani, Carmen Greco, Maria Elisabetta Rossi, Giovanni Sernicola, Alvise Pellacani, Giovanni J Clin Med Article Cutaneous neurosensory symptoms have become increasingly reported findings in COVID-19; however, these virus-related manifestations are largely overlooked, and their pathology is poorly understood. Moreover, alterations of skin sensibility currently recognize no clear histopathology substrate. The purpose of this study was to provide pathology evidence of neurosensory skin system involvement in COVID-19 patients complaining of subjective neurological symptoms affecting the skin. Out of 142 patients, six long COVID-19 cases complaining of cutaneous subjective neurological symptoms assessed on an NTSS-6 questionnaire underwent histopathological and immunohistochemical analyses of skin areas affected by paroxysmal diffuse burning and itching sensations. Two patients also performed electroneurography examination. The histology investigation showed hypertrophic glomus vascular bodies with hypertrophic S100+ perineural sheath cells and adjacent hypertrophy of the nerve branches associated with increased basophil polysaccharide matrix. Electroneurography revealed disturbances of A-delta and C dermal neuronal fibers. The main limitation of this study consisted of a limited number of skin biopsy samples, requiring further investigation. Histopathology findings are consistent with hypertrophy of nerve endings, suggesting a condition such as “dermal hyperneury”, a recently reported small nerve hypertrophy condition affecting sensory C fibers. Such a neuropathic basis could explain dysesthesia experienced by the patients, as previously described in postherpetic neuralgia. MDPI 2022-07-31 /pmc/articles/PMC9369885/ /pubmed/35956094 http://dx.doi.org/10.3390/jcm11154474 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Grieco, Teresa
Gomes, Vito
Rossi, Alfredo
Cantisani, Carmen
Greco, Maria Elisabetta
Rossi, Giovanni
Sernicola, Alvise
Pellacani, Giovanni
The Pathological Culprit of Neuropathic Skin Pain in Long COVID-19 Patients: A Case Series
title The Pathological Culprit of Neuropathic Skin Pain in Long COVID-19 Patients: A Case Series
title_full The Pathological Culprit of Neuropathic Skin Pain in Long COVID-19 Patients: A Case Series
title_fullStr The Pathological Culprit of Neuropathic Skin Pain in Long COVID-19 Patients: A Case Series
title_full_unstemmed The Pathological Culprit of Neuropathic Skin Pain in Long COVID-19 Patients: A Case Series
title_short The Pathological Culprit of Neuropathic Skin Pain in Long COVID-19 Patients: A Case Series
title_sort pathological culprit of neuropathic skin pain in long covid-19 patients: a case series
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9369885/
https://www.ncbi.nlm.nih.gov/pubmed/35956094
http://dx.doi.org/10.3390/jcm11154474
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