I read the CMAJ Practice article on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related chilblains in a 16-year-old female by Ladha and Dupuis1 with interest, but it raised a few concerns. In females in this age group, the association between anorexia nervosa and pernio or chilblains has been noted for several decades.2,3
This case report makes no mention of the patient’s body habitus or body mass index, and there is no description of a physical examination, which is seminal in ruling out autoimmune disorders, such as lupus, or malignant disease. The laboratory investigations are thorough, but a normal chest radiograph and computed tomography scan of the abdomen would have added weight to the final diagnosis of SARS-CoV-2-related chilblains. The dermal pathology of pernio or chilblains is nonspecific4 and, therefore, a skin biopsy is not suggested.4
There is no description of the patient’s smoking history, including e-cigarette usage (“vaping”), as nicotine will exacerbate the vasospasm seen in pernio or chilblains.4
During the current coronavirus disease 2019 pandemic, clinicians are adopting a “hands-off” or telehealth approach to reviewing patients, including history taking. However, there are individuals for whom an office visit and physical examination is important. This may be one of those cases: the positive result for SARS-CoV-2 antibody serology testing may be incidental and unrelated to her skin condition.5
Footnotes
Competing interests: None declared.