The list of symptoms in Coronavirus positive patients has been growing since it originated in Wuhan, China. Enanthem is the latest addition to that, say Spanish researchers. That makes COVID-19 even more difficult to diagnose early.

So far, the World Health Organization (WHO) has listed three common and 10 less acknowledged symptoms of the COVID-19. If, cough, sore throat, and tiredness are common symptoms, diarrhea, loss of smell and taste, aches, skin rash, conjunctivitis, and discoloration of fingers or toes are present in some patients.

What Is Enanthem?

But enanthem is another symptom that Spanish doctors reported in 29 percent of the patients studied. The rash in the mouth is called enanthem which occurs in some viral infections.

Enanthem
Enanthem or mouth rashes may present in a COVID-19 patient Wikimedia Commons

According to Dr Michele Green, a medical practitioner at the Lenox Hill Hospital in New York, "An enanthem is a rash or small spot on the mucous membranes. It is very common in patients with viral infections like chickenpox and hand, foot, and mouth disease. It is characteristic of many viral rashes to affect mucous membranes."

Enanthem A New Symptom?

But as per the study conducted by Dr Juan Jimenez-Cauhe, Dr Daniel Ortega-Quijano, and Dr Dario de Perosanz-Lobo, dermatologists at the Hospital Universitario Ramony Cajal, Madrid, Spain, it has been observed in some patients of COVID-19.

The study which was conducted at a Madrid hospital in April 2020, 21 patients with COVID-19 presented skin rash, and out of them, six patients had enanthem inside their mouth. The patients were aged between 40-69 while most of them were women.

Doctors also observed chickenpox-like vesicles or ulcers in them. Since the mouth rashes were not typical and it varied in patients, doctors split them into four categories of petechial, macular, macular with petechiae, or erythemato-vesicular.

Rashes
Some patients have also presented skin rashes as a symptom of Coronavirus Twitter

The mouth rash, which WHO has not listed as a Coronavirus symptom, appeared two days before to 24 days after other symptoms. While the condition is also associated with side effects of medicines, such was not the case in the studied patients.

"The presence of enanthem is a strong clue that suggests a viral etiology rather than a drug reaction, especially when a petechial pattern is observed," the study said, adding that it was consistent with the skin rashes found in 18 COVID-19 patients in Italy.

The problem with such mouth rashes is that it is hard to detect. Most of the patients with COVID-19 do not get oral exams due to safety concerns and that poses a challenge. The doctors also suggested further study relating to the symptom as the patient group was relatively small.

"This work describes preliminary observations and is limited by the small number of cases and the absence of a control group. Despite the increasing reports of skin rashes in patients with COVID-19, establishing an etiological diagnosis is challenging," concluded the study, which was published in JAMA Network on July 15.