Background: the most commonly reported clinical manifestations of Coronavirus Disease MESHD (COVID- 19) are: fever MESHD fever HP, fatigue MESHD fatigue HP, dry cough MESHD cough HP, anorexia MESHD anorexia HP, myalgias MESHD myalgias HP, dyspnoea and sputum production. Other, rarer, manifestations include headache MESHD headache HP, sore throat, rhinorrhoea, nausea MESHD nausea HP, diarrhoea and olfactory or taste disorders MESHD. Two recent small-scale studies suggest the possibility of a skin rash HP being a clinical presentation of the disease MESHD. The purpose of our case report is to bring attention to an atypical presentation of the disease (skin MESHD skin rash HP) and reflect on the importance of the correct identification of COVID-19 suspicious symptoms as part of the crucial activity of case-finding in primary care.Case presentation: the patient is an Italian 32 years old female TRANS nurse who has had several close contacts TRANS to COVID-19 cases during her working shifts. On the 13 th March 2020 she developed an itchy erythematous papular rash sparing only her sparing only her face, scalp and abdomen. One week later she developed fever MESHD fever HP and diarrhoea. During the first week of remote assessment carried out by her General Practitioner (GP), she gradually developed a dry cough MESHD cough HP, intermittent fever MESHD fever HP and diarrhoea. At the time of article submission (31 days after the symptoms onset TRANS), she has not completely recovered and is still suffering of a dry cough MESHD cough HP, headache MESHD headache HP, fatigue MESHD fatigue HP and, occasionally, diarrhoea.Conclusions: this study suggest that skin manifestations MESHD could be an early presentation of COVID-19 and, during outbreaks, they should be taken into proper account by primary care providers as possibly caused by Sars-Cov-2. Early identification of COVID-19 patients is a crucial part of the strategy of case detection and case isolation, which has shown to be crucial in the reduction of incidence and COVID-19-related mortality. Further research is needed to establish frequency, symptoms, signs MESHD, pathogenesis and role in case detection of skin manifestations MESHD in COVID-19 patients.