Here, we report the case of an 81-year-old woman who presented at the Department of Dermatology at the University Hospital of Basel, Basel, Switzerland, with a temperature of up to 39°C and a generalised macular eruption with partial vasculitis-like patterns and palmoplantar accentuation (appendix pp 1–2). Infection with SARS-CoV-2 was suspected and laboratory assessments of blood samples showed increased C-reactive protein (248 mg/L), decreased lymphocyte count (7·7%), and negative Treponema pallidum serology. A SARS-CoV-2 PCR (nasopharyngeal swab, Cobas SARS-CoV-2 Test, Roche Diagnostics, Rotkreuz, Switzerland) was negative. 2 days later, a lesional whole skin 4 mm punch biopsy sample was taken from the left flank, which showed a subacute lichenoid interface dermatitis with vacuolisation of the basal epidermal keratinocytes and scant lymphohistiocytic perivascular infiltration in the upper dermis. No leukocytoclastic vasculitis or microthrombosis was present (appendix pp 1–2). Over the next 2 weeks, the patient’s rash gradually improved. 6 weeks later, serology tests against anti-SARS-CoV-2 antibodies (Elecsys Anti-SARS-CoV-2, Roche Diagnostics, Rotkreuz, Switzerland) were negative. However, PCR testing of the skin using established methods

detected SARS-CoV-2 at low copy numbers (37 per 1 × 10⁶ human RPPH1 copies).