COVID-19-associated vasculitis is a term used to describe a genuine vasculitis associated with SARS- COV-2 infection when all other possible causes of vasculitis have been ruled-out. We report a case of a 66- year-old-male, reinfected by COVID-19 after 5 months, who presented with a 2-week history of multiple petechiae on bilateral anterior legs that gradually evolved into targetoid purpura with central blisters, spreading to the proximal medial thighs and the trunk, associated with pruritus and a warm sensation over the affected areas. The patient also presented with marked periorbital swelling, abdominal and joint pains, and decreased kidney function. Histopathology of the skin biopsy showed leukocytoclastic vasculitis while direct immunofluorescence study came out positive result for fibrinogen but negative for IgA, IgG, IgM and C3. Skin lesions resolved and kidney function improved prior to discharge after treatment with IV antibiotics (azithromycin 500 mg and ceftazidime 1 g) and IV steroids (hydrocortisone 50 mg). Recurrence of the vasculitic skin lesions occurred 2 weeks after being tagged as COVID-recovered but improved after 14 days of treatment with oral prednisone. We highlight the importance of recognizing cutaneous vasculitis as a possible marker of a severe COVID-19 disease which could be in the form of single-organ damage particularly acute kidney injury.
case report

Key Findings There is currently no evidence to support the use of sanitation tents in the prevention of COVID-19 transmission. • Sanitation tents or disinfection tents have been installed in various areas of the Philippines as a measure to decontaminate individuals and prevent COVID-19 transmission. • The commonly used disinfectant in these tents is diluted household bleach. Others propose to use alcohol or diluted povidone iodine to decontaminate individuals in the tent. • Bleach is an irritant to mucous membranes and loses its antimicrobial effect over time or when exposed to heat and sunlight. • Alcohol is flammable and also causes irritation to mucous membranes. • Povidone iodine may cause skin irritation, chemical pneumonitis when inhaled, and acute kidney injury when systemically absorbed. • There are no completed or ongoing studies on the use of sanitation tents for the prevention of COVID-19 transmission. • To date, there are no guidelines that recommend the use of sanitation tents for prevention of COVID-19 transmission. • The World Health Organization explicitly recommends against spraying alcohol or chlorine all over a person's body due to adverse health effects and the lack of inhibitory activity against viruses that have already entered the body. • The Centers for Disease Control and Prevention note that most environmental protection agency-registered household disinfectants are effective against COVID-19. However, these products are approved for use only on surfaces and not on humans. • The Department of Health guidelines recommend the avoidance of spraying or misting for COVID-19 due to lack of evidence of its efficacy.
Coronavirus ; Covid-19

Histoplasmosis is well-characterized as a fungal disease that more commonly occurs in North America, mostly endemic in Ohio and Mississippi river valleys. The clinical spectrum of histoplasmosis ranges from asymptomatic infection to a fatal disease. Progressive disseminated histoplasmosis is typically seen in immunocompromised individuals and presents with non-specific systemic symptoms associated with cutaneous manifestations of papules and nodules.? We report a case of a 28-year old Filipino female with a history of exposure to soil activities months before consult. The patient presented with a 3-week history of erythematous macules, vesicles, and pustules over the face, arms, and trunk, which evolve into papules and plaques with hemorrhagic crusting. Patient was initially diagnosed and treated as a case of varicella but had no improvement with initial management. Histopathologic findings were consistent with histoplasmosis. The patient was started with oral itraconazole, but unexpectedly expired before any improvement in cutaneous symptoms were noted.
Disseminated histoplasmosis ; Itraconazole