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.