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20 August 2020 : Case report  Italy

A Case of COVID-19 with Late-Onset Rash and Transient Loss of Taste and Smell in a 15-Year-Old Boy

Unusual clinical course, Challenging differential diagnosis, Management of emergency care

Antonino Maniaci1ABEF*, Giannicola Iannella2BCF, Claudio Vicini3BCF, Piero Pavone4BDE, Giuseppe Nunnari4BCF, Raffaele Falsaperla5BCF, Paola Di Mauro1BCD, Salvatore Ferlito1ABE, Salvatore Cocuzza1ABCEF

DOI: 10.12659/AJCR.925813

Am J Case Rep 2020; 21:e925813

Abstract

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic that spread from China is caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). The head and neck region can be variably affected in adult patients, and taste and smell disorders are typical manifestations. However, pediatric clinical signs are less severe, making the onset diagnosis challenging to interpret. The variability of nasal olfactory symptoms in children and adolescents is intertwined with possible warning signs, including gastrointestinal, ocular, or dermatological symptoms. We present a case involving a 15-year-old boy with clinically confirmed COVID-19 who had late-onset rash and transient taste and smell disorders.

CASE REPORT: The boy’s clinical history revealed that a family member was positive for SARS-CoV-2. In the preceding 3 days, the boy’s eating habits had changed; he perceived a metallic taste while eating and had a loss of appetite. He also had erythematous skin lesions on the lower limbs for the 2 previous days. A sore throat, nasal congestion, and a runny nose were reported on head and neck examination. A real-time polymerase chain reaction test was positive, confirming the initial diagnostic hypothesis.

CONCLUSIONS: SARS-CoV-2 virus infection in children and adolescents can be asymptomatic, but it can also occur with fever, dry cough, fatigue, and gastrointestinal symptoms. Due to the unique immune characteristics of pediatric and adolescent patients, the correct interpretation of the gustatory and skin symptoms associated with specific laboratory tests for SARS-CoV-2 infection can lead to the most appropriate management and supportive care.

Keywords: Adult Children, COVID-19, Dysgeusia, SARS Virus, Taste

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923