Erythema Gyratum Repens: A Delayed Manifestation of COVID-19 Infection

Main Article Content

Kareem Elhage
Audrey Fotouhi
Steven Daveluy


Erythema gyratum repens, COVID-19, immunological disease, cutaneous disease


A man in his mid 50’s with a history of recent COVID-19 infection presented to the emergency department (ED) with a cough, chest pain, shortness of breath, and a new rash. Workup included a complete blood count and computed tomography (CT) scan of the thorax, which showed neutrophilic leukocytosis and multiple cavitary lesions in the right lung and superior segment of the left upper lobe. Physical examination showed serpiginous, erythematous plaques on the lower extremities, upper extremities, abdomen, and back. Initially, erythema gyratum repens (EGR) secondary to tuberculosis was considered. However, QuantiFERON-TB Gold testing was negative and bronchiolar lavage fluid grew methicillin-resistant staph aureus (MRSA). Further testing for other etiologies was unremarkable. Due to the characteristic pattern of the rash and resolution shortly after COVID-19 symptoms subsided, a diagnosis of EGR secondary to COVID-19 infection was made. 


1. Rongioletti F, Fausti V, Parodi A. Erythema gyratum repens is not an obligate paraneoplastic disease: a systematic review of the literature and personal experience. J Eur Acad Dermatol Venereol. 2014;28(1):112-115. doi:10.1111/j.1468-3083.2012.04663.x

2. Barber PV, Doyle L, Vickers DM, Hubbard H. Erythema gyratum repens with pulmonary tuberculosis. Br J Dermatol. 1978;98(4):465-468. doi:10.1111/j.1365-2133.1978.tb06543.x

3. Votquenne N, Richert B. Erythema Gyratum Repens. JAMA Dermatology. 2020;156(8):912. doi:10.1001/jamadermatol.2020.1694

4. Eubanks LE, Mcburney E, Reed R. Erythema Gyratum Repens. The American Journal of the Medical Sciences. 2001;321(5):302-305. doi:10.1097/00000441-200105000-00002

5. Boyd AS, Neldner KH, Menter A. Erythema gyratum repens: a paraneoplastic eruption. J Am Acad Dermatol. 1992;26(5 Pt 1):757-762. doi:10.1016/0190-9622(92)70107-q

6. Erythema gyratum repens following COVID‐19 infection - Peres - 2021 - International Journal of Dermatology - Wiley Online Library. Accessed November 7, 2022.

7. Erythema gyratum repens after COVID‐19 - Castro Silva - 2021 - Journal of the European Academy of Dermatology and Venereology - Wiley Online Library. Accessed November 7, 2022.

8. Hamming I, Timens W, Bulthuis MLC, Lely AT, Navis GJ, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol. 2004;203(2):631-637. doi:10.1002/path.1570

9. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study - PubMed. Accessed November 7, 2022.

10. Samotij D, Szczech J, Bencal-Kusinska M, Reich A. Erythema gyratum repens associated with cryptogenic organizing pneumonia. Indian J Dermatol Venereol Leprol. 2016;82(2):212-213. doi:10.4103/0378-6323.173594

11. Erythema gyratum repens after COVID vaccination - Chiquito - 2022 - Journal of the European Academy of Dermatology and Venereology - Wiley Online Library. Accessed November 7, 2022.