Case 1
A 29-year old woman presented to the dermatologic clinic with multiple sclerotic skin eruptions all over her body. She mentioned a history of SARS-CoV-2 infection 4 months earlier. A few days after being infected, she had developed maculopapular lesions beginning from the upper extremities progressing to the trunk and lower extremities. The eruptions gradually turned to sclerotic lesions (figure1). She did not have any comorbidities and her medication history was not significant except for a course of interferon beta-1a during her SARS-CoV-2 infection. Complete blood count, chemistry panel, liver, renal and thyroid function tests and coagulation parameters were in normal range. Complement component C3 and C4, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and ferritin levels were within normal limits. Serologic tests for ACE, ANA, RF, Anti-dsDNA, AntiRo, Anti La, Anti Sm, Anti Jo1, AntiScl70, Anti RNP, Anti-centromere, Anti-CCP, and FANA antibodies were negative. Moreover, assessment results for tumor markers, hepatitis B virus (HBV) and hepatitis C virus (HCV) were also negative. Abdominopelvic ultrasound did not reveal any abnormality. We took skin biopsy of the eruptions, which demonstrated the epidermis overlying by basket weave cornified layer with basilar pigmentation and also the dermis infiltrated by perivascular and slight interstitial lympho-histiocytes and scattered plasma cells, with sclerotic change and diminished adnexa, all suggestive for morphea. We treated the patient with topical corticosteroids, but no response was observed. Therefore, we recommended the patient to undergo phototherapy. At the current time, she has passed her second phototherapy session with no considerable response. Yet, we are expecting to observe improvement with more prolonged duration of therapy.