Hydroxychloroquine

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An event is serious (based on the ICH definition) when the patient outcome is:

• * death

• * life-threatening

• * hospitalisation

• * disability

• * congenital anomaly

• * other medically important event

A 95-year-old woman developed erythema multiforme-like rash following off-label treatment with hydroxychloroquine for COVID-19 pneumonia.

The woman was hospitalised with dyspnoea, fever and an itchy, cutaneous rash. Two days prior to her current admission, she had been discharged following recovery from COVID-19 pneumonia, for which she had been treated with hydroxychloroquine [route and dosage not stated] for 10 days. Physical examination at the time of her current admission showed typical target and targetoid lesions on her trunk and extremities, with confluent purpuric macules on her lower limbs. However, her mucous membranes were spared. Chest X-ray revealed patches of increased density in both hemithorax, with peripheral predominance. These findings were minimally aggravated, as compared to the radiographic findings prior to discharge. Sputum culture showed the presence of SARS-CoV-2. Blood count revealed mild leukocytosis with neutrophilia. Large, granular lymphocytes were noted in a blood smear. Serological analysis for parvovirus B19 infection demonstrated positive IgG and negative IgM. A superficial perivascular and interstitial dermatitis with predominantly mononuclear inflammatory infiltrate was observed on a skin biopsy of a thigh lesion. The erythema multiforme-like rash was attributed to the COVID-19 infection, and to the off-label therapy with hydroxychloroquine [time to reaction onset not clearly stated].

The woman was treated with unspecified topical corticosteroids. She also received symptomatic treatment for the fever and dyspnoea. A gradual, progressive improvement of her skin lesions was noted.