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Discordant anti‐SARS‐CoV ‐2 spike protein and RNA staining in cutaneous perniotic lesions suggests endothelial deposition of cleaved spike protein
Author(s) -
Ko Christine J.,
Harigopal Malini,
Gehlhausen Jeff R.,
Bosenberg Marcus,
McNiff Jennifer M.,
Damsky William
Publication year - 2021
Publication title -
journal of cutaneous pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.597
H-Index - 75
eISSN - 1600-0560
pISSN - 0303-6987
DOI - 10.1111/cup.13866
Subject(s) - immunohistochemistry , staining , pathology , in situ hybridization , rna , microbiology and biotechnology , epithelium , biology , messenger rna , medicine , gene , biochemistry
Background Prior studies have shown the presence of immunohistochemical staining for the SARS‐CoV‐2 spike protein (SP) in endothelial cells and eccrine epithelium of acral perniosis classified as “COVID toes.” Yet, other studies have been unable to detect SARS‐CoV‐2 RNA in skin biopsies of “COVID toes” by reverse‐transcriptase polymerase chain reaction testing. Objective In order to address these apparently conflicting findings, we compared detection of SARS‐CoV‐2 SP, through RNA in situ hybridization (ISH) vs immunohistochemistry (IHC), in skin biopsies of acral perniotic lesions presenting during the COVID‐19 pandemic. Results Three of six cases showed positive immunohistochemical labeling of endothelial cells, with one of three cases with sufficient depth also having labeling of eccrine glands, using an anti‐SP SARS‐CoV‐2 antibody. These three cases positive with IHC were negative for SP by RNA ISH. Conclusion While the gold standard for detection of SARS‐CoV‐2 in tissue sections has yet to be determined, the detection of SARS‐CoV‐2 SP alone without spike RNA suggests that cleaved SP may be present in cutaneous endothelial cells and eccrine epithelium, providing a potential pathogenetic mechanism of COVID‐19 endotheliitis.