Severe acute dried gangrene in COVID-19 infection: a case report

E. Novara, E. Molinaro, I. Benedetti, R. Bonometti, E.C. Lauritano, R. Boverio

Department of Emergency Medicine, IRCCS San Matteo Hospital Foundation University of Pavia, Pavia, Italy. elena.novara01@ateneopv.it

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• Infectious Diseases

OBJECTIVE: Coronavirus disease 2019 (COVID-19) related coagulopathy may be the first clinical manifestation even in non-vasculopathic patients and is often associated with worse clinical outcomes.
CASE PRESENTATION: A 78 years old woman was admitted to the Emergency Unit with respiratory symptoms, confusion and cyanosis at the extremity, in particular at the nose area, hands and feet fingers. A nasal swab for COVID-19 was performed, which resulted positive, and so therapy with doxycycline, hydroxychloroquine and antiviral agents was started. At admission, the patient was hemodynamically unstable requiring circulatory support with liquids and norepinephrine; laboratory tests showed disseminated intravascular coagulation (DIC). During hospitalization, the clinical condition worsened and the cyanosis of the nose, fingers, and toes rapidly increased and became dried gangrene in three days. Subsequently, the neurological state deteriorated into a coma and the patient died.
DISCUSSION: In severe cases, COVID-19 could be complicated by acute respiratory disease syndrome, septic shock, and multi-organ failure. This case report shows the quick development of dried gangrene in a non-vasculopathic patient, as a consequence of COVID-19’s coagulopathy and DIC.
CONCLUSIONS: In our patient, COVID-19 related coagulopathy was associated with poor prognosis.

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