From Your Nose to Your Toes: A Review of Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic‒Associated Pernio
Lisa M. Arkin, John J. Moon, Jennifer M. Tran, Samira Asgari, Cliona O’Farrelly, Jean‐Laurent Casanova, Edward W. Cowen, Jacqueline W. Mays, Anne Marie Singh, Beth A. Drolet, Alessandro Aiuti, Alexandre Bélot, Alexandre Bolze, Анастасія Бондаренко, Anna Šedivá, Anna Shcherbina, Anna M. Planas, Antônio Condino‐Neto, Aurora Pujol, Beth A. Drolet, Biggs Catherine, Carlos Flores, Carlos Rodríguez‐Gallego, Carolina Prando, Clifton L. Dalgard, Cliona O’Farrelly, Colobran Roger, Davoud Mansouri, Diederik van de Beek, Donald C. Vinh, Elena W.Y. Hsieh, Evangelos Andreakos, Filomeen Haerynck, K. M. Furkan Uddin, Giorgio Casari, Giuseppe Novelli, Graziano Pesole, Isabelle Meyts, Ivan Tancevski, Jacques Fellay, Jean‐Laurent Casanova, Jordi Pérez‐Tur, Kai Kisand, Keisuke Okamoto, Kristina Mironska, Laurent Abel, Laurent Rénia, Lisa F. P. Ng, Mohammed Shahrooei, Pere Soler‐Palacín, Petter Brodin, Qiang Pan‐Hammarström, Rabih Halwani, Rebeca Pérez de Diego, Saleh Al‐Muhsen, Sara Elva Espinosa‐Padilla, Satoshi Okada, Tayfun Özçelık, Ahmad Abou Tayoun, Timokratis Karamitros, Trine H. Mogensen, YL Lau
Abstract
Despite thousands of reported patients with pandemic-associated pernio, low rates of seroconversion and PCR positivity have defied causative linkage to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pernio in uninfected children is associated with monogenic disorders of excessive IFN-1 immunity, whereas severe COVID-19 pneumonia can result from insufficient IFN-1. Moreover, SARS-CoV-2 spike protein and robust IFN-1 response are seen in the skin of patients with pandemic-associated pernio, suggesting an excessive innate immune skin response to SARS-CoV-2. Understanding the pathophysiology of this phenomenon may elucidate the host mechanisms that drive a resilient immune response to SARS-CoV-2 and could produce relevant therapeutic targets.