Document Type: Case Reports

Authors

Dr Sadi Konuk Training and Research Hospital, Department of Pathology, Istanbul, Turkey

Abstract

Coronavirus is a single-stranded RNA virus that causes acute respiratory syndrome and various skin lesions. In addition, ischemic acral lesions have been reported in patients with severe coronavirus disease 2019 (COVID-19) due to coagulation disorders. We here present a case with ischemic acral lesions caused by COVID-19. The patient was 51-year old male who was hospitalized with COVID-19 pneumonia. After 28 days in the Intensive Care Unit, patient developed acroischemic lesions in the fingers and toes. In the histopathologic examination, vasculitis was observed as the infiltration of mixed-type inflammatory cells in the mid-sized muscular arteries wall. Moreover, microthrombosis was detected in small capillaries. It is clear that thrombotic lesions have occurred as a result of COVID-19 or administered treatment. Further studies are required to confirm and better characterize the skin reactions in COVID-19.

Keywords

Main Subjects

  1. World Health Organization. Coronavirus disease 2019 (COVID-19): situation report-37. February 25, 2020. Accessed February 26, 2020
  2. Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, et al. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up . J Am Coll Cardiol. 2020; S0735-1097(20)35008-7.
  3. Marzano, A. V., Genovese, G., Fabbrocini, G., Pigatto, P., Monfrecola, G., Piraccini, B. M., et al. Varicella-like exanthem as a specific COVID-19-associated skin manifestation: Multicenter case series of 22 patients J Am Acad Dermatol. 2020; S0190-9622(20)30657-5. [DOI:10.1016/j.jaad.2020.04.044] [PMID] [PMCID]
  4. Tian S, Xiong Y, Liu H, Niu L, Guo J, Liao M, et al. Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core. Mod Pathol. 2020; 14:1-8. [DOI:10.20944/preprints202003.0311.v1]
  5. Galván Casas C, Català A, Carretero Hernández G, Rodríguez-Jiménez P, Fernández Nieto D, Rodríguez-Villa Lario A, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol. 2020;10.1111/bjd.19163. [DOI:10.1111/bjd.19163] [PMID] [PMCID]
  6. Fernandez-Nieto D, Jimenez-Cauhe J, Suarez-Valle A, Moreno-Arrones OM, Saceda-Corralo D, Arana-Raja A, et al. Characterization of acute acro-ischemic lesions in non-hospitalized patients: a case series of 132 patients during the COVID-19 outbreak. J Am Acad Dermatol. 2020;S0190-9622(20)30709-X. [DOI:10.1016/j.jaad.2020.05.120] [PMID]
  7. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol. 2020;34(5):e212‐e213. [DOI:10.1111/jdv.16387]
  8. Hedou M, Carsuzaa F, Chary E, Hainaut E, Cazenave-Roblot F, Masson Regnault M. Comment on "Cutaneous manifestations in COVID-19: a first perspective " by Recalcati S. J Eur Acad Dermatol Venereol. 2020;10.1111/jdv.16519. [DOI:10.1111/jdv.16519] [PMID] [PMCID]
  9. Mazzotta F, Trocoli T. Acute acro-ischemia in the child at the time of COVID-19. Eur. J.Pediat. Dermatol. 121.2 (2020): 172-175.
  10. Jimenez-Cauhe J, Ortega-Quijano D, Carretero-Barrio I, Suarez-Valle A, Saceda-Corralo D, Moreno-Garcia Del Real C, et al. Erythema multiforme-like eruption in patients with COVID-19 infection: clinical and histological findings. Clin Exp Dermatol. 2020;10.1111/ced.14281. [DOI:10.1111/ced.14281] [PMID] [PMCID]
  11. Tang K, Wang Y, Zhang H, Zheng Q, Fang R, Sun Q. Cutaneous manifestations of the Coronavirus Disease 2019 (COVID-19): A brief review. Dermatol Ther. 2020; e13528. [DOI:10.1111/dth.13528] [PMCID]
  12. Cordoro KM, Reynolds SD, Wattier R, McCalmont TH. Clustered Cases of Acral Perniosis: Clinical Features, Histopathology and Relationship to COVID-19. Pediatr Dermatol. 2020;10.1111/pde.14227. [DOI:10.1111/pde.14227] [PMID] [PMCID]
  13. Piccolo V, Neri I, Filippeschi C, Oranges T, Argenziano G, Battarra VC, et al. Chilblain-like lesions during COVID-19 epidemic: a preliminary study on 63 patients. J Eur Acad Dermatol Venereol. 2020;10.1111/jdv.16526. [DOI:10.1111/jdv.16526] [PMCID]
  14. Hernández-Rodríguez J, Alba MA, Prieto-González S, Cid MC. Diagnosis and classification of polyarteritis nodosa. J Autoimmun. 2014;48-49:84‐89. doi:10.1016/j.jaut.2014.01.029 [DOI:10.1016/j.jaut.2014.01.029] [PMID]
  15. Xiong M, Liang X, Wei YD. Changes in blood coagulation in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Br J Haematol. 2020;10.1111/bjh.16725. [DOI:10.1111/bjh.16725] [PMID] [PMCID]
  16. Tian S, Xiong Y, Liu H, Niu L, Guo J, Liao M, Xiao SY. Pathological study of the 2019 novel coronavirus disease (COVID-19) through postmortem core biopsies. Mod Pathol. 2020; 14:1-8. [DOI:10.20944/preprints202003.0311.v1]