A case of late ulceration of infantile hemangioma in the setting of SARS-CoV2 infection

ACE: angiotensin-converting enzyme AngII: angiotensinogen II FGF: fibroblast growth factor IH: infantile hemangiomas RAS: renin-angiotensin system VEGF: vascular endothelial growth factor INTRODUCTION Infantile hemangiomas (IH) are the most frequent pediatric vascular tumors affecting 5% to 10% of children in their first few weeks. Ulceration is the most frequent complication reported in IH, with an incidence rate ranging from 10% to 30%. Often found during the height of the proliferative phase (fastest growth rate at week 5-8 weeks) by 4 months of age. Risk factors for ulceration include large size, segmental orientation, mixed morphology, and flexural locations. Propranolol, with its effect on vascular tone, angiogenesis, and apoptosis, has proven to be an excellent treatment option and has been the drug of choice since 2008. Ulceration beyond 2 years of age, particularly when the hemangioma had been fully treated and was quiescent off of treatment, is very unusual. Since its declaration as a global pandemic by the World Health Organization inMarch 2020, SARS-CoV2 virus, also known as COVID-19, has significantly impacted most medical fields. For the dermatologist, cutaneous complications related to SARS-CoV-2 virus infection have steadily increased. Commonly described manifestations include urticaria, maculopapular exanthemas, vesicular eruption, and acral vasculopathic rash similar to chilblains lesions and referred to as ‘‘COVID toe.’’ Mucocutaneous ulcerations are rarely recorded in association with the infection and are mainly limited to genital or oral ulcers.