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J Eur Acad Dermatol Venereol. 2013 Mar 21. doi: 10.1111/jdv.12145. [Epub ahead of print]

The prognostic role of the new entity butterfly-like facial rash and cutaneous findings in patients with crimean congo haemorrhagic fever.

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Department of Dermatology, Medicalpark Samsun Hospital, Medicalpark Health Group, Samsun, Turkey.



Crimean Congo Haemorrhagic Fever (CCHF) is a deadly fever caused by Nairovirus (family Bunyaviridae). It is an important public health problem in hyperendemic regions with a high mortality rate. There have been many studies on cutaneous findings in other viral infections, however, our knowledge is limited regarding CCHF. The aim of this study was to evaluate the cutaneous manifestations of CCHF and their relationship with mortality.


Patients who were diagnosed CCHF between April 1 and September 1, 2011 were enrolled in this study. Dermatologic examination and laboratory analysis were obtained during hospitalization.


A new entity that is first reported in this study as a butterfly-like facial rash was recognized in 76 patients (42.9%). It was not correlated with mortality but could coexist with other dermatological signs of CCHF. The major outcome was the increased mortality rate with other cutaneous findings (especially ecchymosis, purpura and petechia) (P < 0.01). While 12 deceased individuals had one or more skin findings, only one patient died without any cutaneous manifestations. Mortality rate was higher in patients with purpura than the patients with pethesia. The statistically significant correlation was observed between cutaneous manifestations and elevation of aspartate aminotransferase (AST) levels (P = 0.009). Platelet levels were lower in patients with cutaneous involvement (P < 0.01). No statistically significant relationship was found between cutaneous findings and alanine aminotransferase (ALT), white blood cell (WBC), Haemoglobin (Hb), creatinine kinase (CK) and lactate dehydrogenase (LDH) levels.


Histopathologic examination of facial rash could not be done because of haemostatic failure.


The results of this study confirm that cutaneous findings can be a clue regarding the prognosis of the patients with CCHF. Physicians should be aware that CCHF may present with a butterfly-like rash on the face.


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