Two Different Clinical Presentations of Acute Limb Ischemia Caused by Acute Thrombotic Events in COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Coagulopathy is frequently found in severe cases of COVID-19 and is usually manifested as a prothrombotic state. Hyperinflammation, endotheliitis, and immobilization during illness are hypothesized to play a role. Acute limb ischemia (ALI) is one of the presentations of arterial thrombosis in COVID-19. We present two cases of middle-aged men with COVID-19 infection, who developed ALI. The first patient developed ALI after 16 days from the initial COVID-19 diagnosis, and the second patient was admitted to the emergency ward due to sudden discoloration of his right lower limb, and COVID-19 was diagnosed during the evaluation.

A dry gangrene signing SARS-CoV2 infection in a vulnerable patient

“…This process induces organ damage, release of proinflammatory cytokines, chemokines, and activation of the complement system which all lead to the hyperinflammation state known as "cytokine storm" 2 . Both microvascular dysfunction and cytokine storm are involved in thrombotic and ischemic manifestations 3 . Several studies have reported different signs of acral ischemia such as pseudo-chilblains, livedo reticularis and dry gangrene [4][5][6] .…”

“…However, its role in arterial diseases has been less demonstrated 1,2 . Cases of acute limb ischemia and different signs of acro-ischemia in infected patients have been reported [3][4][5][6] . We report a case of dry gangrene in a patient tested positive for SARS-CoV2 without respiratory symptoms.…”