PT - JOURNAL ARTICLE AU - Sandeep Pagali AU - Riddhi S Parikh TI - Severe urticarial rash as the initial symptom of COVID-19 infection AID - 10.1136/bcr-2021-241793 DP - 2021 Mar 01 TA - BMJ Case Reports PG - e241793 VI - 14 IP - 3 4099 - http://casereports.bmj.com/content/14/3/e241793.short 4100 - http://casereports.bmj.com/content/14/3/e241793.full SO - BMJ Case Reports2021 Mar 01; 14 AB - A 54-year-old woman presented with pruritic rash and hives of 3 days’ duration followed by shortness of breath for 1 day. SARS-CoV-2 PCR test for COVID-19 was positive. Cutaneous manifestations of COVID-19 include acral lesions, urticarial rash, erythematous maculopapular rash, vascular rashes and vesicular rash. The cutaneous manifestations are mostly described as self-limiting. Urticarial rashes are not reported as the initial presentation symptom of COVID-19 infection but mostly noted to occur at the same time or after the onset of non-cutaneous symptoms. Management of cutaneous manifestations of COVID-19 affecting quality of life has not been well studied. Antihistamine therapy is the primary recommended therapy. Role of antiviral therapy for severe cases of rash needs to be further assessed.