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Requests for reprints should be addressed to Kosuke Ishizuka, MD, PhD, Division of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae, Kawasaki-city, Kanagawa pref. Japan.
A 39-year-old Japanese woman developed a fever and cough and was diagnosed with coronavirus disease 2019 (COVID-19) infection 2 months prior. Both symptoms resolved spontaneously within a few days. However, 1 week later, tingling pain and wheals appeared over her entire body, sparing her head and the distal portion of the extremities. They appeared a few minutes after bathing and quickly resolved with cooling (Figure). The patient was diagnosed with cholinergic urticaria using an acetylcholine injection test, which induced both pain and wheals. No suggestive findings of anhidrosis were observed in a thermoregulatory sweat test. Symptoms improved with oral administration of antihistamine.
Cholinergic urticaria is a skin disorder triggered by sweating or stimuli that simulate sweating, such as bathing.