PMC7350968_01
(A) Exuberant tonsillopharyngitis with whitish exudate. (B) Hyperaemia and ulcerative lesions (white arrow) in the anterior pillars of the fauces and soft palate
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PMC7350968_01_1609_Fig1.jpg
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Severe odynophagia began the following day, which prompted examination by a physician, who documented exuberant tonsillopharyngitis with whitish exudate (Fig. 1A). Oropharyngeal examination revealed hyperaemia and ulcerative lesions in the anterior pillars of the fauces, soft palate and tonsils bilaterally; at that time no exudate was observed (Fig. 1B).
(A) Small crusted lesions adjacent to the lateral commissures of the mouth and around the nostrils. (B) Inflammatory signs in the distal extremity of the second finger of the left hand
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PMC7350968_01_1609_Fig2.jpg
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On the 3rd day, small pruritic vesicles developed adjacent to the lateral commissures of the mouth and around the nostrils, which later became crusted (Fig. 2A). Later that day, the patient described pain on the distal extremity of the second finger of the left hand and in the third and fourth fingers of the right hand, associated, hours later, with rubor and oedema (Fig. 2B).
Petechial pruritic rash on the distal extremities of the fingers (A) and on the calcaneus area (B)
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PMC7350968_01_1609_Fig3.jpg
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A non-pruritic papular rash was documented on the abdomen, trunk and limbs, with a distinct petechial pruritic rash on the palms and soles of the feet, more exuberant on the distal extremities of the fingers (Fig. 3A) and on the calcaneus area (Fig. 3B).
Skin desquamation in the in the calcaneus area (A) and distal extremities of all fingers (B)
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PMC7350968_01_1609_Fig4.jpg
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Approximately 10 days after complete recovery from the viral syndrome, the patient developed skin desquamation in the distal extremities of all fingers (Fig. 4B) as well as in the calcaneus area (Fig. 4A), in the same areas where the petechial rash had been more exuberant.
Onychomadesis in the second finger of the left hand (A) and third and fourth fingers of the right hand (B)
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PMC7350968_01_1609_Fig5.jpg
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Six and a half weeks after recovery, the patient also presented onychomadesis (detachment of the nail plate from the nail matrix) on the second finger of the left hand (Fig. 5A) and third and fourth fingers of the right hand (Fig. 5B), also the fingers that previously presented inflammatory signs.