Abstract

Introduction: Grover Disease following COVID-19 infection is a relatively uncommon phenomenon among cutaneous SARS-Cov-2 manifestations, presenting as pruritic papulovesicular eruptions on the trunk. Case Presentation: A 50-year-old immunocompetent female presented with a diffuse skin eruption that began 5 days after onset of respiratory symptoms, for which she tested positive for SARS-Cov-2. The patient reported the rash burned and itched. Past medical history was noncontributory; she reported a childhood chickenpox infection. Physical examination was notable for erythematous-to-violaceous, scaly, crusted papules located on the trunk and all four extremities. There were occasional pustules and an intact vesicle on the right thigh. Varicella PCR was negative. The rash was not biopsied but was clinically consistent with reports of vesicular-pustular, varicella-like eruptions following COVID-19. The patient received antihistamines and triamcinolone ointment for symptomatic relief. Upon follow-up 5 months later, the patient had multiple new erythematous scaly papules primarily on the trunk. Routine labs and inflammatory markers were normal. Given the eruption’s evolution, a punch biopsy of an abdominal lesion was performed. Histopathologic examination demonstrated digitate elongation of the rete with subtle acantholysis and rare dyskeratotic cells. There was overlying parakeratosis and a dermal perivascular infiltrate of lymphocytes and rare eosinophils. The findings of elongation of the rete with acantholysis suggested Galli-Galli Disease; however, given the clinical context, a variant of Grover Disease was more likely given reported associations with COVID-19 infection. Conclusion: We present a case of COVID-19-related varicella-like eruption that evolved over several months to Grover Disease with Galli-Galli-type morphology. This case represents a unique histologic variant of Grover Disease among the growing body of SARS-Cov-2-related cutaneous manifestations.

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