Angioedema and urticaria as early presentations of a COVID-19 patient: a case report

Coronavirus disease 2019 (COVID-19) usually presents with fever, sore throat, myalgia, cough, and respiratory symptoms 1, but sometimes features unusual cutaneous manifestations 2. Dermatological manifestations might be due to direct viral invasion or immunological response 3. Here, we describe a COVID-19 case with prodromal manifestations of angioedema and urticaria. In August 2020, a 46 year-old-woman was admitted to the Emergency Department with a five-day history of a widespread, red, raised, blanching, itchy rash, which started from the lower extremities and gradually extended to the trunk and upper extremities. She had no fever, myalgia, or cough and had no allergy to drugs or food, except for a possible allergy to peanuts. Also, she had no previous airway diseases or asthma. She had not taken any NSAIDs or ACE inhibitors in the preceding two weeks. On the admission day, the rash extended, with swelling of the lips and eyelids. After 24 hours, a non-productive cough was added to the skin lesions. Her temperature was 36.2° C, pulse rate was 98 beats/min, oxygen saturation was 98% in room air, and respiratory rate was 16 times/min. On physical examination, diphenhydramine (10 mg TID). The patient’s swelling significantly improved two days later and disappeared on day 4 (Figure 1c). She was discharged in a stable condition on day 5, and prednisolone was continued for five more days.